Epidemiology of transitional cell carcinoma of the bladder: Profile of an urban population in the south-west of England

Objectives: To produce an epidemiological profile of patients with transitional cell carcinoma (TCC) of the bladder living in the city of Bristol (south-west England), to determine if TCC tumorigenesis is linked to possible risk factors (occupational exposure, cigarette smoking, alcohol consumption and coffee consumption) and to assess phenotypic acetylation status and thus determine whether there may be a genetic component to tumour development. Patients and methods: This cross-sectional observational epidemiological study recruited both cases and controls from one-stop haematuria clinics, providing two groups with a similar age and sex distribution. Before diagnosis, all patients were interviewed by the same researcher and results recorded on a specially designed database questionnaire, to eliminate both recall and investigator bias. Metabolic studies were also performed before diagnosis. Results: There were significant associations for occupational exposure, cigarette smoking, and beer consumption (but not wine or spirits), but no significant association with coffee consumption. Slow acetylation status also conferred an increased risk. There were linear trends in terms of dose-response for both beer and cigarette consumption, although this was significant only for cigarettes. There was no difference in risk between the use of filtered or unfiltered cigarettes. Conclusion: Occupational exposure and cigarette smoking have been well documented as risk factors in the development of TCC of the bladder, as has slow acetylation status. There are very few studies linking bladder cancer with alcohol consumption. It is important to subdivide types of alcohol consumed when considering this factor in an epidemiological study. In the case of beer, methods used by different brewing processes may also contribute to differences found, were such a study to be performed on a national scale.