Wu Xifeng, Ros Martine M, Gu Jian, Kiemeney Lambertus
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
BJU Int. 2008 Nov;102(9 Pt B):1207-15. doi: 10.1111/j.1464-410X.2008.07961.x.
The incidence of bladder cancer varies considerably among countries; the highest incidence rates are in Western communities. The variation in occurrence can partly be explained by differences in registration and coding practices of pTa tumours. Factors that modify the occurrence of bladder cancer are smoking and exposure to many kinds of carcinogenic substances in the workplace. Evidence also exists for radiotherapy to the pelvis, infection with Schistosoma haematobium, and certain medications as risk factors for bladder cancer. Despite enormous efforts, other important environmental or lifestyle factors that clearly and consistently increase or decrease the risk of bladder cancer have not been identified. Bladder cancer in first-degree relatives doubles the risk of bladder cancer; this increased risk might be due to high-penetrance susceptibility genes in a small subset of families, but most of this risk is probably caused by common lower-penetrance DNA variants that influence risk through one or more different cancer pathways. In the next 2 years genome-wide association scans will probably yield important new information on such variants. This might also facilitate new studies on lifestyle factors restricted to groups of susceptible people. In the future it will also be necessary to pay more attention to potential risk factors for different types of bladder cancer, more specifically low- vs high-grade cancer. The ultimate goal is to build a risk-prediction model by integrating environmental and genetic factors that can project individualized probabilities of developing bladder cancer.
膀胱癌的发病率在不同国家之间存在很大差异；发病率最高的是西方社会。发病率的差异部分可以通过pTa肿瘤登记和编码方式的不同来解释。影响膀胱癌发生的因素包括吸烟以及在工作场所接触多种致癌物质。也有证据表明盆腔放疗、感染埃及血吸虫以及某些药物是膀胱癌的危险因素。尽管付出了巨大努力，但尚未确定其他明显且持续增加或降低膀胱癌风险的重要环境或生活方式因素。一级亲属患膀胱癌会使患膀胱癌的风险加倍；这种风险增加可能是由于一小部分家庭中存在高 penetrance 易感性基因，但这种风险大部分可能是由常见的低 penetrance DNA 变异通过一种或多种不同的癌症途径影响风险所致。在未来两年内，全基因组关联扫描可能会产生有关此类变异的重要新信息。这也可能有助于针对易感人群组开展关于生活方式因素的新研究。未来还需要更加关注不同类型膀胱癌的潜在危险因素，尤其是低级别与高级别癌症。最终目标是通过整合环境和遗传因素构建一个风险预测模型，该模型能够预测个体患膀胱癌的概率。
