Reports of unusual clinical cases in the medical literature have contributed to our understanding of the disease spectrum, especially with regard to cancer and exposure to suspected environmental factors. It was projected that in 1980 there would be 35,500 newly diagnosed bladder cancer cases in the United States, which would be the cause of approximately 5 per cent of all cancer deaths in male subjects. There are few reports on bladder cancer of familial susceptibility and genetic predisposition, with only 4 such families described in the literature. We report one rural family with 3 cases of transitional cell carcinoma in 2 generations.