Shariat - Figure 8
Impact of smoking and smoking cessation on NMIBC progression (n=2433)
FIG. 8: The first risk factor that always comes to mind is that patients with bladder cancer have a high likelihood of being smokers. It is estimated that, depending on the country, up to two-thirds of patients with bladder cancer have the cancer secondary to the carcinogenic effect of tobacco use.
In NMI bladder cancer, smokers have been shown to have a higher rate of failure to respond to BCG,[8] and a higher likelihood of disease progression and mortality.[9] There is a dose-effect, with heavy long-term smokers being at highest risk. There is also an effect of smoking cessation in bladder cancer that is similar to that in other diseases, eg, cardiovascular disease. For example, if patients stop smoking they revert to the same likelihood of reported biological aggressiveness of the tumor as that of nonsmokers starting from 10 years forward. An interesting observation is that females who smoke seem to have a worse prognosis than males.[10]
Taking all of this together, diagnosis of a T1 high-grade bladder cancer in a smoker represents an impetus for counseling and smoking cessation intervention. It is a teachable moment, and urologists should be at the forefront of management of smoking-related cancers and cancer progression prevention.
References
Rink M, Xylinas E, Babjuk M, et al. Smoking reduces the efficacy of intravesical bacillus Calmette-Guérin immunotherapy in non-muscle-invasive bladder cancer. Eur Urol. 2012;62:1204−6 http://dx.doi.org/10.1016/j.eururo.2012.08.057
Rink M, Furberg H, Zabor EC, et al. Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. Eur Urol. 2013;63:724-32 https://doi.org/10.1016/j.eururo.2012.08.025
Rink M, Xylinas E, Trinh Q-D, et al. Gender-specific effect of smoking on upper tract urothelial carcinoma outcomes. BJU Int 2013;112:623–37 https://doi.org/10.1111/bju.12014
