ASSOCIATIONS BETWEEN BLADDER-CANCER RISK-FACTORS AND TUMOR STAGE AND GRADE AT DIAGNOSIS

Using data on 1,860 bladder cancer cases and 3,934 population-based co ntrols from the National Bladder Cancer Study, we examined association s between suspected bladder cancer risk factors and tumor stage and gr ade. Employment in a high-risk occupation was associated-with the enti re clinical spectrum of bladder cancer rather than a particular tumor stage or grade. For example,relative risks (RR) were similar for nonin vasive and invasive disease (1.5 and 1.6, respectively). Cigarette smo king also increased risk of the entire clinical spectrum of bladder ca ncer, but the more advanced the stage, the stronger the effect. For ex ample, relative risks of noninvasive and invasive bladder cancer for c urrent heavy smokers were 3.0 and 5.2, respectively. Cigarette Smoking was associated with higher risk of low-grade than high-grade tumors, once stage of disease was taken into account. Compared with whites, no nwhites were at a lower risk of noninvasive bladder cancer (RR = 0.4) but at similar risk of invasive bladder cancer (RR = 1.1), a pattern i ndicating racial differences in health practices related to bladder ca ncer detection. History Of urinary tract infections and bladder stones was associated with increasing relative risks for advanced tumor stag e. Heavy artificial sweetener Use was associated with higher-grade, po orly differentiated tumors. Coffee consumption and family history of b ladder cancer were not consist entry associated with tumor stage or gr ade. Overall, different clinical presentations of bladder cancer share most suspected bladder cancer risk factors, including employment in a high-risk occupation and cigarette smoking.