Body mass and smoking are modifiable risk factors for recurrent bladder cancer

Authors

  • Asaf Wyszynski PhD,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
    2. Program in Experimental and Molecular Medicine, Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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  • Sam A. Tanyos BS,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Judy R. Rees BM, BCh, PhD,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Carmen J. Marsit PhD,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
    2. Program in Experimental and Molecular Medicine, Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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  • Karl T. Kelsey MD,

    1. Department of Epidemiology and Department of Pathology and Laboratory Medicine, Center for Environmental Health and Technology, Brown University, Providence, Rhode Island
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  • Alan R. Schned MD,

    1. Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Eben M. Pendleton BS,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Maria O. Celaya MPH,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Michael S. Zens PhD,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Margaret R. Karagas PhD,

    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • Angeline S. Andrew PhD

    Corresponding author
    1. Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
    • Corresponding author: Angeline S. Andrew, PhD, Dartmouth Medical School, Section of Biostatistics and Epidemiology, 7927 Rubin 860, One Medical Center Drive, Lebanon, NH 03756; Angeline.Andrew@dartmouth.edu

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  • We thank the staff and participants of the New Hampshire Health Study and the New Hampshire State Cancer Registry for making this project possible.

Abstract

BACKGROUND

In the Western world, bladder cancer is the fourth most common cancer in men and the eighth most common in women. Recurrences frequently occur, and continued surveillance is necessary to identify and treat recurrent tumors. Efforts to identify risk factors that are potentially modifiable to reduce the rate of recurrence are needed.

METHODS

Cigarette smoking behavior and body mass index were investigated at diagnosis for associations with bladder cancer recurrence in a population-based study of 726 patients with bladder cancer in New Hampshire, United States. Patients diagnosed with non–muscle invasive urothelial cell carcinoma were followed to ascertain long-term prognosis. Analysis of time to recurrence was performed using multivariate Cox regression models.

RESULTS

Smokers experienced shorter time to recurrence (continuing smoker hazard ratio [HR] = 1.51, 95% confidence interval [CI] = 1.08-2.13). Although being overweight (body mass index > 24.9 kg/m2) at diagnosis was not a strong independent factor (HR = 1.33, 95% CI = 0.94-1.89), among continuing smokers, being overweight more than doubled the risk of recurrence compared to smokers of normal weight (HR = 2.67, 95% CI = 1.14-6.28).

CONCLUSIONS

These observational results suggest that adiposity is a risk factor for bladder cancer recurrence, particularly among tobacco users. Future intervention studies are warranted to evaluate whether both smoking cessation and weight reduction strategies reduce bladder tumor recurrences. Cancer 2014;120:408–414. © 2013 American Cancer Society.

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