Gender- and smoking-related bladder cancer risk

J Natl Cancer Inst. 2001 Apr 4;93(7):538-45. doi: 10.1093/jnci/93.7.538.


Background: There is growing evidence that, when smoking habits are comparable, women incur a higher risk of lung cancer than men. Because smokers are also at risk for bladder cancer, we investigated possible sex differences in the susceptibility to bladder cancer among smokers.

Methods: A population-based, case--control study was conducted in Los Angeles, CA, involving 1514 case patients with bladder cancer and 1514 individually matched population control subjects. Information on tobacco use was collected through in-person interviews. Peripheral blood was collected from study participants to measure 3- and 4-aminobiphenyl (ABP)-hemoglobin adducts, a marker of arylamine exposure. Data were analyzed to determine whether the risk of bladder cancer differs between male and female smokers and whether female smokers exhibit higher levels of ABP-hemoglobin adducts than male smokers with comparable smoking habits. All statistical tests were two-sided.

Results: Cigarette smokers had a statistically significant 2.5-fold higher risk (95% confidence interval = 2.1 to 3.0) of bladder cancer than never smokers. Use of filtered versus nonfiltered cigarettes, low-tar versus higher tar cigarettes, or the pattern of inhalation did not modify the risk. The risk of bladder cancer in women who smoked was statistically significantly higher than that in men who smoked comparable numbers of cigarettes (P =.016 for sex-lifetime smoking interaction). Consistent with the sex difference in smoking-related bladder cancer risk, the slopes of the linear regression lines of the 3- and 4-ABP--hemoglobin adducts by cigarettes per day were statistically significantly steeper in women than in men (P values for sex differences <.001 and.006, respectively).

Conclusion: The risk of bladder cancer may be higher in women than in men who smoked comparable amounts of cigarettes.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Hemoglobins / analysis
  • Humans
  • Incidence
  • Linear Models
  • Los Angeles / epidemiology
  • Male
  • Middle Aged
  • Risk
  • Risk Factors
  • Sex Factors
  • Smoking / adverse effects*
  • Urinary Bladder Neoplasms / blood
  • Urinary Bladder Neoplasms / epidemiology*
  • Urinary Bladder Neoplasms / etiology*


  • Hemoglobins
  • hemoglobin, 3-aminobiphenyl-
  • hemoglobin, 4-aminobiphenyl-