Tag Archive | "Bladder Cancer"

Paint Exposure May Increase Bladder Cancer Risk

A new meta-analysis study published in the journal Occupational and Environmental Medicine reported that people who work with paint in their jobs seem to be at a 25% increased risk of bladder cancer.

An additional study that controlled for smoking status discovered a similar result, leading the researchers to conclude a casual relationship between paint exposure and bladder cancer.  ”The robustness of the summary risk estimates after adjusting for tobacco use [suggests] that residual confounding by tobacco use is unlikely and that occupational exposure as a painter is independently associated with the risk of bladder cancer,” the researchers wrote.

Neela Guha, PhD, MPH commented that, “because several million people are employed as painters worldwide, even a modest increase in the relative risk is remarkable.”As a result, the International Agency for Research on Cancer (IARC) now classifies exposure to paint as “carcinogenic to humans.” The magnitude of the risk was greater with longer term paint exposure. In addition to painters; plasterers, glaziers, wallpaper hangers, aerographers, artists, decorators, and French polishers were also deemed at risk.

Although the specific chemicals responsible for the increased risk have yet to be identified, Guha and her colleagues observed that painting exposes individuals to many of the same carcinogens found in cigarette smoke. “To permit identification of specific causative agents encountered in the painting environment, future studies assessing cancer risks in painters should present risk estimates associated with individual components in paint,” the researchers commented.

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High-grade Bladder Cancer Patients Not Receiving Recommended Care

In a recently published study in Cancer, researchers at UCLA’s Jonsson Comprehensive Cancer Center found that just one in 4,545 people with high-grade noninvasive bladder cancer was treated according to the comprehensive care guidelines set by the American Urological Association and the National Comprehensive Cancer Network.

The cells in a patient with high-grade cancer show greater abnormality than cells in a patient with a low-grade tumor.  Guidelines for high-grade cancer require an initial injection of chemotherapy drugs directly into the bladder to kill cancer cells and an intense follow-up surveillance schedule that involves using a scope to assess the bladder (cystoscopy) and urine testing (cytology) four times a year.  This chemotherapy shot should be followed by a six-week course of Bacillus Calmette-Guerin (BCG) treatment, which creates an inflammatory response, causing the body to attack the cancer.  Also recommended is imaging of the upper urinary tract with a CT scan, MRI scan, or renal ultrasound at diagnosis and every two years.

Researchers found that compliance with these guidelines had more to do with the doctors treating the patients than with the patients’ age, race, or economic status.  They concluded that the guidelines my not be reaching urologists at community hospitals, which is where the majority of patients receive treatment.

The authors’ suggestions for increasing compliance rates included modifying reimbursement rates and conducting more research to identify factors inhibiting comprehensive treatment.  Karim Chamie, M.D., a postdoctoral fellow in urologic oncology and health services and the lead author of the study, believes that meeting the recommended guidelines for high-grade bladder cancer patients will significantly reduce the mortality rate.

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Study Finds Strong Association Between Smoking and Risk for Bladder Cancer

Data from a large cohort study showed that smoking’s contribution to bladder cancer risk increased over the past 25 years, and the attributable risk in women caught up with that of men.

Current smokers increased risk of bladder cancer by four times compared to people who never smoked.  The risk among former smokers two times that of people who never smoked.  Previous cohort studies had shown about a threefold increased risk of bladder cancer among current smokers.

According to a recent article published in JAMA, smoking accounted for about half of the population-attributable risk of bladder cancer in men and women alike.

This apparent association between smoking and bladder cancer could reflect changes in cigarette manufacturing.

From the 1980s, the rates of bladder cancer in the U.S. has remained stable, ranging from 123.8 to 142.2 cases per 100,000 person-years in men, and from 32.5 to 33.2 cases per 100,000 person-years in women.

The authors noted in their introduction that the prevalence of smoking and cigarette composition have changed considerably during the same period, which perhaps changes the nature of the association between smoking and bladder cancer.

Neal D. Freedman, PhD, of the National Cancer Institute in Bethesda, Md., and co-authors revisited risk estimates for smoking and bladder cancer by examining data from the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study.

The NIH-AARP cohort study had follow-up data through December 31, 2006.  The participants, who were ages 50 to 71 at enrollment, completed a lifestyle questionnaire during 1995 and 1996.  This follow-up continued until the end of the study, a diagnosis of bladder cancer, a move outside the study’s catchment area, or death.

State cancer registries provided bladder cancer diagnoses information.  The foma; analysis included 281,394 men and 186,134 women.  During 4,518,941 person-years of follow up, 3,896 men had new diagnoses of bladder cancer, resulting in an incidence of 144 per 100,000 person-years.  During this same follow-up period, 627 women had a new diagnosis of bladder cancer for an incidence of 34.5 per 100,000 person-years.  Rates among people who never smoked were 69.8 and 16.1 per 100,000 person-years in men and women, respectively.  These rates increased to 154.6 and 276.4 per 100,000 person-years among men who were former or current smokers. Corresponding rates in women were 40.7 and 73.6 per 100,000 person-years.

The research team performed a systematic review and meta-analysis of prospective cohort studies of current smoking and bladder cancer started between 1963 and 1987.

Limitations of the study included lack of information on the year smoking had started and lack of follow-up data on smoking after the baseline survey to know how many people may have quit.

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C-choline Offers No Advantage for Bladder Cancer Scans

Israeli researchers have recently reported that using C-choline as a tracer in positron emission tomography/computerized tomography (PET/CT) for staging urothelial carcinoma offers no advantages over fluorine-18 2-flouro-2-deoxy-D-glucose (F18-FDG).  In fact, C-choline may perform worse.

Shay Golan, MD, of Rabin Medical Center found that despite initial optimism, the use of the novel trace C-choline in PET/CT did not improve the detection of extravesical transitional cell carcinoma, compared with F-18 FDG.  FDG had a tendency toward an improved accuracy.  These results were published in the Journal of Urology.

Dr. Golan, Petah Tikva, and colleagues found that for bladder cancer staging FDG PET/CT has not shown a clear advantage over contrast CT, which may be due to urinary excretion of FDG masking the uptake.

Initial studies supported the view that because C-choline has negligible excretion into the urinary system, this would make it a potentially better metabolic marker.  To investigate this hypothesis, the research team used both methods to evaluate local and metastatic disease in 20 patients with bladder cancer.  Fifty-one lesions showed abnormal tracer activity.  C-choline had a positive predictive value of 84.7% for all detected lesions. For FDG, the proportion was 90.7%. Corresponding values for extravesical lesions were 79.4% and 88.2%.  There were discrepant findings at eleven sites and FDG found four lymph nodes metastases that were missed using C-choline.  Nevertheless, bladder tumor involvement was unrecognized by FDG in three cases in which C-choline clearly showed increased uptake.

The research team concluded that despite the limitations of their preliminary study, they found that the diagnostic performance of PET/CT in the detection of metastatic urothelial carcinoma was not improved when C-choline was used as the tracer.

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Survival Chances Not Affected by Chemotherapy Before or After Bladder Cancer Surgery

According to a report in the peer-reviewed journal Cancer, in advanced bladder cancer, receiving chemotherapy before or after surgery does not affect survival, as long as it is given perioperatively.

Lead author James M. McKierman, MD, said that there is no clear cut randomized data to suggest that chemotherapy is better to give before or after surgery.  With his colleagues at Columbia University Medical Center, McKierman reviewed data on 146 patients who received multiagent platinum-based systemic chemotherapy for locally advanced bladder cancer between 1988 and 2009. Half of them received neoadjuvant chemotherapy, and the other half was treated postoperatively.

The team found no significant difference in overall or disease-specific survival between groups in the 122 patients treated with cisplatin-based protocols.  The median survival with neoadjuvant versus adjuvant therapy was 11 months versus 12.5 months, respectively.    This was also true when patients received methotrexate/vinblastine/adriamycin/cisplatin (median survival, 16 months versus 22.2 months).  Additionally, there was no significant difference between neoadjuvant and adjuvant cisplatin- or carboplatin-based chemotherapy.

There was, however, a significant difference observed in the 43 patients who received gemcitabine/cisplatin.  Postoperative treatment for this group was associated with a significantly reduced survival.  The team calls for further studies to clarify this finding, but they emphasize that these patients probably had worse pre-chemotherapy characteristics, including decreased performance status.

The study concluded there were no significant differences overall in survival between patients treated with chemotherapy before or after radical cystectomy.  Dr. McKiernan that this finding should be “considered when counseling patients regarding the sequence of perioperative chemotherapy and should be validated with a prospective randomized trial.”

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Pioglitazone (Actos) Drug Suspended in France and Germany Due to Possible Bladder Cancer Link

Diabetes drug Actos (pioglitazone), sold by Takeda Pharmaceutical’s have been suspended in France and Germany because of its potential bladder cancer risk which was seen in tests of male rats.

Actos was approved for use in Europe in 2000.

In France, after an official French study found that the drug appeared to slightly raise the risk of bladder cancer, France’s drug safety authority suspended the use of Actos. In addition it also suspended the use of Competact which combines the use of pioglitazone and metformin.

Germany followed suit after receiving results of the study by France’s national health insurance body which tracked patients on diabetes drug between 2006 and 2009.

Both the French and German regulators said patients currently being prescribed Actos should continue to take their medications until they could consult with their doctors.

A spokewoman for European Medicines Agency said it wasn’t aware of any other national authorities taking action.

Britain’s drugs regulator said it was not recommending any changes to Actos use while the European review was going on and the Danish medicines agency also had no plans on suspending the drug.

In the United States, FDA initiated a safety review of Actos last September but Takeda said U.S. regulators had not signaled any intention to request a recall.

GlaxoSmithKline’s Avandia (rosiglitazone) which belongs to the same drug class as Actos was pulled from the market in Europe and had severe restrictions imposed on its use in the United States last September after being linked to heart risks.  Avandia has not been associated with bladder cancer.

U.S. health insurer Kaiser Permanente conducted trials in 2003 and is slated to last 10 years have so far not confirmed a clear association between Actos and bladder cancer.

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NSAID May Have Anti-Bladder Cancer Benefit

People taking non-steroidal anti-inflammatory drugs or NSAIDs such as naproxen (Aleve) and ibuprofen (Advil) more than twice a week may have a lesser chance of getting bladder cancer.

The research combined data from three previous studies where authors of each of those studies had asked participants how frequently they took different kinds of medications, including aspirin and NSAIDs, and then tracked how many of them were diagnosed with bladder cancer over the following years.

Researchers followed as much as half a million people with an average age of 62 at the beginning of the study for an average of 7 years.  About 2,500 people were diagnosed with bladder cancer, 4 out of 5 were men. One in 185 people who never took NSAIDs developed bladder cancer.  One in 244 people who took NSAIDs more than twice a week got bladder cancer.

There are a lot of possible reasons why people who take NSAIDs regularly might be less at risk for bladder cancer. A possible explanation is that most likely the inflammation caused by the bacteria or virus makes the DNA mutations that lead to cancer and NSAIDs cut down the inflammation therefore reducing the chance of a cancer developing or spreading.

Lead researcher Dr. Sarah Daugherty from the National Institutes of Health said “based on our results, it would be premature to make recommendations to patients” to take NSAIDs.  The study cannot prove that NSAIDs are responsible for lowering the risk of bladder cancer, and the finding does not mean taking NSAIDs every day is the best choice for everyone. NSAIDs have side effects which includes ulcers.

The research did not find a reduced risk of bladder cancer in people who regularly took aspirin, also an anti-inflammatory.

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Cheese and Bladder Cancer

Regularly eating large portions of cheese could increase the risk of bladder cancer, according to a new study.

Researchers recently found that the risk of bladder cancer increased by more than 50 percent in those patients who ate more than 53 grams, or 1.8 ounces, of cheese a day.  This amount of cheese is about the same weight as a small chocolate bar.  Eating less than this portion did not appear to increase the danger.

On the other hand, a daily portion of olive oil can reduce the risk of developing the condition by more than half.

The results were published in a recent issue of the European Journal of Cancer.  The study evaluated dietary fats’ influence on an individual’s chances of getting bladder cancer.

Nearly 10,000 people a year in the United Kingdom develop bladder cancer.  Even worse, about 60,000 people in the United States fall victim to the disease.  And smokers are four times more likely to get it than non-smokers.

Even if you successfully avoid smoking and cheese, many other risks exist.  We may be constantly exposed to harmful chemicals in the workplace.  Further, repeated bouts of bladder infections increase the risk.

But past studies have produced conflicting evidence on whether different types of fats prevent cancer or increase the chances of it occurring.

A team of Dutch and Belgian researchers decided to put an end to the uncertainty by studying saturated fats.  These types of fats are found in our meat and dairy products and were found to make cancer more likely.  The scientists did find that healthier fats, like olive oil, offer some protection.

The study analyzed 200 bladder cancer victims and their eating habits.  These results were compared to the eating habits and health of 386 volunteers who had not developed tumors.

Overall, the results showed eating cheese had little effect unless the amount exceeded 53 grams a day.  After this amount, the risk went up by more than half.

The effects of milk were also observed.  Findings show that it does appear to raise cancer risk; however, the results are not statistically significant.  Fish, chicken, eggs, and margarine appear to have little effect.

Findings such as these are incredibly important to the health of the Western populations.  In 1997, most people in the UK were eating around 103 grams a week.  But by 2009, that amount had risen to 116 grams, indicating a 13 percent increase in the last decade.  The West’s diet high in saturated fat may explain why its populations have the highest rates of bladder cancer in the world.

In contrast, the Mediterranean diet is rich in olive oil and plant foods, which may reduce the odds of developing the disease.  Yet high smoking rates in this part of the world put the region at a risk similar to that found in northern Europe.

The study does acknowledge that the sample size may be too small to conclude that cheese is a major health threat.  The lead researchers are calling for further investigations to verify the findings.  In a report on their study researchers stated, “We found a potentially protective effect from a high intake of olive oil and a suggestive increased risk from high cheese consumption.  But these results need to be confirmed by other studies.”

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Red Meat and Bladder Cancer: No Link

Based on new analysis of data published in the journal Cancer Epidemiology, Biomarkers & Prevention, researchers have stated that no association exists between consuming fresh or processed red meat and an increased risk of bladder cancer.  The study was led by Paula Jakszyn from the Catalan Institute of Oncology in Spain.  Her researchers also noted that no link was found between nitrosamines and heme iron and bladder cancer risk.

“To our knowledge this is the first prospective study of heme iron intake and bladder cancer risk,” the researchers wrote.  “The strengths of this study include its large size, prospective design and inclusion of potential confounding variables.”

Jakszyn and her team began the investigation of the association between red meat consumption, dietary nitrosamines and heme iron and the risk of bladder cancer in order to iron out inconsistent results from previous epidemiological studies.  The study focused on 520,000 participants from Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden, and the United Kingdom.  These patients were part of the European Prospective Investigation into Cancer Nutrition (EPIC).  The results of the study showed no overall association between intake of red meat, nitrosamines or heme iron and bladder cancer risk.

Further, the associations did not vary by sex, high vs. low risk bladder cancers, smoking status, or occupation.  When assessing red and processed meat separately, no differences were observed.

EPIC investigates the relationships between diet, nutritional status, lifestyle, and environmental factors and the incidence of cancer and other chronic diseases.

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BCG Treatment for Bladder Cancer

Bacillus Calmette-Guerin or BCG is used as a vaccine against tuberculosis.  In addition, it is also used as a treatment for bladder cancer.

BCG therapy is often used after the cancer has been removed through bladder surgery to prevent a recurrence. It is also used to treat the early stages of superficial bladder cancer that do not require surgery.

There are two separate theories as to how BCG is able to treat bladder cancer. The first is that the immune response that BCG is able to generate in the bladder also activates the immune system against cancer cells. The other theory is that the inflammation caused by a BCG infection is also toxic against cancer cells. Regardless, BCG has been shown to be an effective therapy against bladder cancer.

It is administered in the doctor’s office and delivered directly into the bladder through a urinary catheter. Patients are required to empty their bladder immediately before treatment and then to not urinate for at least 2 hours. During this 2 hour, the patient will need to change position every 15 minutes so that their entire bladder receives the solution.  The patient is instructed to lie on his back, stomach and each side for 15 minutes at a time.  The treatment is usually given weekly for 6 weeks.

Several hours after the treatment, patients should drink extra fluids to flush the bladder. To disinfect the toilet after the treatment, patients should dilute their urine with household bleach for 6 hours after the treatment.  In order to kill any live BCG bacteria, bleach should be added to the toilet after urinating and allowed to sit for 15 minutes before flushing.

Common side effects of BCG treatment include pain or a burning sensation when urinating, as well as increased frequency and urgency of urination. Patients may also feel fatigue, pain in their joints and mild fever/chills. Other side effects are nausea, diarrhea, stomach pain and loss of appetite. These symptoms are typical of a bladder infection and tend to be fairly mild and disappear after a few days.   BCG may also cause serious side effects like hepatitis, pneumonitis, allergic reaction, lowered white blood cell count, blood in urine, bladder contractions and abscess.

BCG therapy is used with caution in patients with weakened immune systems as well as those receiving treatments that compromise the immune system.

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