Environmental factors in superficial bladder cancer. Preliminary report of a prospective study

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Abstract n. 827 - XIXth EAU Congress. Vienna, 24-27/03 2004. European Urology Suppl. 3,
(2004) No 2
V. Serretta1, V. Altieri2, G. Morgia3, R. Allegro1, M. Pavone-Macaluso1, D. Melloni4, A. Di Lallo5, A. Gallo6, A. Saita7, M. Motta7, L. Salzano8, L. Cindolo8, A. Zito9. A study from Gruppo Studi Tumori Urologici (GSTU)10.
1University, Urology, Palermo, Italy, 2University, Urology, Napoli, Italy, 3University, Urology, Sassari, Italy, 4University, Urology, Messina, Italy, 5Civic Hospital, Urology, Campobasso, Italy, 6I.N.T. Pascale, Urology, Napoli, Italy, 7University, Urology, Catania, Italy, 8Civic Hospital Rummo, Urology, Benevento, Italy, 9Civic Hospital, Urology, Torre Del Greco, Italy, 10Sicilia, Calabria, Campania, Molise, Puglia, Italy


Introduction & Objectives
Although the pathogenetic role in bladder cancer of sigarette smoking and employment is well defined, other environmental factors have not been extensively studied. Case-control studies require high numbers and are expensive. As a preliminary approach to define the object of larger casecontrol studies, the distribution of potential risk factors coming from environmental pollution among patients affected by superficial bladder cancer (TCCB) has been prospectively analized.
Material & Methods
The analysis was limited to patients affected by medium risk superficial TCCB. Patients with primary single Ta G1-2, Tis or T1G3 tumors were excluded. Forty Italian urological centres joined the study. Detailed  informations about age, sex, urban or extra-urban residency, employment, active and passive cigarette smoking, water resource, hair-dye use were centralized. All patients underwent TUR and early intravesical chemotherapy. The distribution of the above mentioned environmental factors was analyzed in relation to tumor characteristics such as multiplicity and previous natural history.
Until now today 474 patients have been recruited, 182 (38.4%) with primary tumors and 293 (61.8%) with multiple lesions. Over 80% of the patients lived in urban areas, 20% were employed in industry and 8% used hair dye. Forty percent of the patients were smokers, with a median smoking period of 30 years. One third have smoked cigarettes in the past. Bottled water was the only water resource for 42% of the patients. At multivariate statistical analysis a significant correlation between tumor multiplicity and employment in industry (p<0.01) and between past natural history and period of cigarette smoking (p<0.05) was found. Preliminarly, an interesting trend was detected for a correlation between water resource and bladder cancer in non-smoking patients. For non-smokers the civic water system was the main water resource more frequently than for smokers (75% vs 53%). This might imply a role of water resource and chlorination as an
enviromental risk factor. Updated data will be presented.

Industry employment and period of cigarette smoking were statistically related to multiplicity and previous history of the tumor. In non-smokers water resource can be implied as an enviromental risk factor. Further and larger case-control studies are required. Acknowledgements: The study was supported in part  byMinistero Italiano dell’Istruzione, Università e Ricerca (MIUR).


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