Modifiable risk factors for the prevention of bladder cancer: a systematic review of meta-analyses

• Published in: European Journal of Epidemiology Vol. 31; no. 9; pp. 811 - 851
• Main Authors: Al-Zalabani, Abdulmohsen H., Stewart, Kelly F. J., Wesselius, Anke, Schols, Annemie M. W. J., Zeegers, Maurice P.
• Format: Journal Article Book Review
• Language: English
• Published: Dordrecht Springer 01.09.2016; Springer Netherlands; Springer Nature B.V
• Subjects: Antioxidants; Bladder cancer; Cancer; Cancer risk; Cardiology; Cigar smoking; Cigarette smoking; Citrus; Diet; Disease prevention; Epidemiology; Exercise; Female; Fruits; Humans; Infectious Diseases; Male; Medical diagnosis; Medicine; Medicine & Public Health; Meta-analysis; Meta-Analysis as Topic; Occupational Exposure - adverse effects; Occupations; Oncology; Pipe smoking; Predisposing factors; Prevention; Public Health; REVIEW; Risk Factors; Selenium; Smoking; Smoking - adverse effects; Smoking cessation; Urinary Bladder Neoplasms - etiology; Urinary Bladder Neoplasms - prevention & control; Vegetables; Vitamin D; Prevention; Obesity; Occupation; Lifestyle; Bladder cancer; Risk factors; Smoking
• ISSN: 0393-2990; 1573-7284
• DOI: 10.1007/s10654-016-0138-6

Each year, 430,000 people are diagnosed with bladder cancer. Due to the high recurrence rate of the disease, primary prevention is paramount. Therefore, we reviewed all meta-analyses on modifiable risk factors of primary bladder cancer. PubMed, Embase and Cochrane database were systematically searched for meta-analyses on modifiable risk factors published between 1995 and 2015. When appropriate, meta-analyses (MA) were combined in meta-meta-analysis (MMA). If not, the most comprehensive MA was selected based on the number of primary studies included. Probability of causation was calculated for individual factors and a subset of lifestyle factors combined. Of 1496 articles identified, 5 were combined in MMA and 21 were most comprehensive on a single risk factor. Statistically significant associations were found for current (RR 3.14) or former (RR 1.83) cigarette smoking, pipe (RR 1.9) or cigar (RR 2.3) smoking, antioxidant supplementation (RR 1.52), obesity (RR 1.10), higher physical activity levels (RR 0.86), higher body levels of selenium (RR 0.61) and vitamin D (RR 0.75), and higher intakes of: processed meat (RR 1.22), vitamin A (RR 0.82), vitamin E (RR 0.82), folate (RR 0.84), fruit (RR 0.77), vegetables (RR 0.83), citrus fruit (RR 0.85), and cruciferous vegetables (RR 0.84). Finally, three occupations with the highest risk were tobacco workers (RR 1.72), dye workers (RR 1.58), and chimney sweeps (RR 1.53). The probability of causation for individual factors ranged from 4 to 68 %. The combined probability of causation was 81.8 %. Modification of lifestyle and occupational exposures can considerably reduce the bladder cancer burden. While smoking remains one of the key risk factors, also several diet-related and occupational factors are very relevant.