The risk of smoking-related secondary cancers developing in bladder ca
ncer patients was studied. The study population consisted of 10,014 bl
adder cancer patients reported to the Finnish Cancer Registry between
1953 and 1989. The risk of contracting a new primary cancer was estima
ted as a standardized incidence ratio, defined as the ratio of the obs
erved and expected numbers of cases. Of 660 secondary cancers (6.6%) o
bserved (standardized incidence ratio 0.96) 44% were considered to be
smoking-related. Lung cancer was the most common secondary cancer (30%
overall), and it occurred significantly more often than expected (sta
ndardized incidence ratio 1.31, 95% confidence interval 1.13 to 1.50).
Also, larynx cancer among men (standardized incidence ratio 1.67, 95%
confidence interval 0.95 to 2.79) and kidney cancer among women (stan
dardized incidence ratio 3.55, 95% confidence interval 1.84 to 6.20) w
ere found more often than expected. These excess risks were observed u
p to 20 years after diagnosis of bladder cancer. Therefore, bladder ca
ncer patients experience an excess risk of smoking-related new tumors,
which must be acknowledged during the initial evaluation and regular
followup of such patients.