Trends in stage-specific incidence rates for urothelial carcinoma of the bladder in the United States: 1988 to 2006

Authors

  • Matthew E. Nielsen MD, MS,

    Corresponding author
    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
    3. Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
    • Corresponding author: Matthew E. Nielsen, MD, MS, Department of Urology, University of North Carolina School of Medicine, 2107 Physicians Office Building, Campus Box 7235, Chapel Hill, NC 27599; Fax: (919) 966-0098; mnielsen@med.unc.edu

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  • Angela B. Smith MD,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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  • Anne-Marie Meyer PhD,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
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  • Tzy-Mey Kuo PhD,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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  • Seth Tyree MS,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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  • William Y. Kim MD,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Division of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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  • Matthew I. Milowsky MD,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Division of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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  • Raj S. Pruthi MD,

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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  • Robert C. Millikan PhD

    1. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
    2. Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
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    • Deceased


  • The authors would like to acknowledge the anonymous reviewers, whose constructive feedback resulted in substantial improvements to the study.

Abstract

BACKGROUND

Bladder cancer is notable for a striking heterogeneity of disease-specific risks. Among the approximately 75% of incident cases found to be superficial to the muscularis propria at the time of presentation (non–muscle-invasive bladder cancer), the risk of progression to the lethal phenotype of muscle-invasive disease is strongly associated with stage and grade of disease. Given the suggestion of an increasing percentage of low-risk cases in hospital-based registry data in recent years, the authors hypothesized that population-based data may reveal changes in the stage distribution of early-stage cases.

METHODS

Surveillance, Epidemiology, and End Results (SEER) data were used to examine trends for the stage-specific incidence of bladder cancer between 1988 and 2006, adjusted for age, race, and sex, using Joinpoint and nonparametric tests.

RESULTS

The adjusted incidence rate of papillary noninvasive (Ta) predominantly low grade (77%) disease was found to increase from 5.52 to 9.09 per 100,000 population (P < .0001), with an average annual percentage change of +3.3. Over the same period, concomitant, albeit smaller, decreases were observed for flat in situ (Tis) and lamina propria-invasive (T1) disease (2.57 to 1.19 and 6.65 to 4.61 per 100,000 population [both P < .0001]; average annual percent change of −5.0 and −1.6, respectively). The trend was most dramatic among patients in the oldest age strata, suggesting a previously unappreciated cohort phenomenon.

CONCLUSIONS

The findings of the current study should motivate further epidemiological investigations of differential associations of genetic and environmental factors with different bladder cancer phenotypes as well as further scrutiny of clinical practice guideline recommendations for the growing subgroup of predominantly older patients with lower-risk disease. Cancer 2014;120:86–95. © 2013 American Cancer Society.

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