Environmental and occupational exposures and prognosis in patients with non-muscle-invasive bladder cancer in the Be-Well Study

Am J Epidemiol. 2024 Jun 3;193(6):863-873. doi: 10.1093/aje/kwad236.


Bladder cancer is primarily diagnosed as non-muscle-invasive bladder cancer (NMIBC), with high recurrence and progression rates. Environmental and occupational exposures to carcinogens are well-known risk factors for developing bladder cancer, yet their effects on prognosis remain unknown. In the Be-Well Study, a population-based prospective cohort study of 1472 Kaiser Permanente patients newly diagnosed with NMIBC in California from 2015 to 2019, we examined history of environmental and occupational exposures in relation to tumor stage and grade at initial diagnosis by multivariable logistic regression, and subsequent recurrence and progression by Cox proportional hazards regression. Exposure to environmental and occupational carcinogens was significantly associated with increased risk of progression (hazard ratio (HR) = 1.79; 95% CI, 1.04-3.09), specifically with increased progression to muscle-invasive disease (HR = 2.28; 95% CI, 1.16-4.50). Exposures to asbestos and arsenic were associated with increased odds of advanced stage at diagnosis (asbestos: odds ratio (OR) = 1.43 [95% CI, 1.11-1.84]; arsenic: OR = 1.27 [95% CI, 1.01-1.63]), and formaldehyde exposure was associated with increased risk of recurrence (HR = 1.38; 95% CI, 1.12-1.69). Our findings suggest that considering a patient's history of these exposures may benefit current risk stratification systems in better tailoring clinical care and improving prognosis among patients with NMIBC.

Keywords: environmental exposure; grade; non–muscle-invasive bladder cancer; occupational exposure; progression; recurrence; stage.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arsenic / adverse effects
  • Arsenic / toxicity
  • Asbestos / adverse effects
  • California / epidemiology
  • Disease Progression
  • Environmental Exposure* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging
  • Non-Muscle Invasive Bladder Neoplasms
  • Occupational Exposure* / adverse effects
  • Occupational Exposure* / statistics & numerical data
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Urinary Bladder Neoplasms* / epidemiology
  • Urinary Bladder Neoplasms* / pathology


  • Asbestos
  • Arsenic