An international study of smoking and bladder cancer.

The effects of smoking cigarettes and other forms of tobacco on the development of cancer of the lower urinary tract (bladder cancer) were evaluated in Boston, Massachusetts, Manchester, United Kingdom and Nagoya, Japan. Population-based series of incident cases and controls were identified and interviewed in each area. The present analyses were based on 592 cases and 533 controls in Boston, 553 cases and 731 controls in Manchester, and 290 cases and 588 controls in Nagoya. Smokers of cigarettes had about twice the incidence of bladder cancer as nonsmokers. In men the strength of the association between cigarette smoking and bladder cancer was similar in the 3 study areas. The strength of the association varied somewhat from area to area among women. Bladder cancer risk increased with frequency of cigarette smoking and with deep inhaling. In Boston men who smoked 2 or more packs of cigarettes per day and inhaled deeply had nearly 7 times the risk of nonsmokers. Ex-smokers had a level of risk between that of current smokers and nonsmokers. However, there was no clear relationship between risk and age at which cigarette smoking began, time since discontinuation among ex-smokers and use of filters. Over-all, there was little difference in bladder cancer risk between men who had and who had not smoked pipes but pipe smoking did appear to be associated with risk among men who had never smoked cigarettes. Cigar smoking was unrelated to bladder cancer.