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# Bladder Cancer
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June 9, 2015
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The following is information regarding bladder cancer, one of the 15 health conditions covered by the VA for Camp Lejeune victims.  The information is a collection of excerpts from various authorities, including the American Cancer Society, the NIH, the Environmental Health Journal and others.
The American Cancer Society’s estimates for bladder cancer in the United States for 2015 are:
* About 74,000 new cases of bladder cancer diagnosed (about 56,320 in men and 17,680 in women).
* About 16,000 deaths from bladder cancer (about 11,510 in men and 4,490 in women).
Bladder cancer occurs mainly in older people. About 9 out of 10 people with this cancer are over the age of 55. The average age at the time of diagnosis is 73. Men are about 3 to 4 times more likely to get bladder cancer during their lifetime than women. Overall, the chance men will develop this cancer during their life is about 1 in 26. For women, the chance is about 1 in 90. In about half of all cases, patients are first diagnosed with bladder cancer while it is still confined to the inner layer of the bladder (non-invasive or in situ cancer). About 35% have bladder cancer that has invaded into deeper layers but is still contained in the bladder. In most of the remaining cases, the cancer has spread to nearby tissues outside the bladder. Rarely (in about 4% of cases), it has spread to distant sites.
Risk Factors:
* Smoking
* **Workplace Exposures –** *Certain industrial chemicals have been linked with bladder cancer. Chemicals called aromatic amines, such as benzidine and beta-naphthylamine, which are sometimes used in the dye industry, can cause bladder cancer. Workers in other industries that use certain organic chemicals also may be at risk for bladder cancer if exposure is not limited by good workplace safety practices. The industries carrying highest risks include the makers of rubber, leather, textiles, and paint products as well as printing companies. Other workers with an increased risk of developing bladder cancer include painters, machinists, printers, hairdressers (likely because of heavy exposure to hair dyes), and truck drivers (likely because of exposure to diesel fumes).*
* Race & Ethnicity
* Age
* Gender
* Chronic Bladder Irritation & Infections
* Personal History of Bladder or other Urothelial Cancer
* Bladder Birth Defects
* Genetics & Family History
* Chemotherapy & Radiation Therapy
* Certain Medicines & Herbal Supplements
* Arsenic in Drinking Water
* Low Fluid Consumption
Symptoms include:
* Blood in your urine
* A frequent urge to urinate
* Pain when you urinate
* Low back pain
Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and biologic therapy. Biologic therapy boosts your body’s own ability to fight cancer.
---
This review investigates the links between environmental risk factors and bladder cancer.
**Environmental Health Journal Article on Carcinogens & Bladder Cancer: <
**Takeaways:**
“The most notable risk factor for development of bladder cancer is **occupational exposure to aromatic amines (2-naphthylamine, 4-aminobiphenyl and benzidine) and 4,4′-methylenebis(2-chloroaniline)**, which can be found in the products of the chemical, dye and rubber industries as well as in hair dyes, paints, fungicides, cigarette smoke, plastics, metals and motor vehicle exhaust.”
**“It is worth noting that it may take several years or decades between exposure and the subsequent cancer.”**
### **Occupational Exposure**
**Aromatic amines**
The most notable risk factor for the development of bladder cancers is occupational exposure to aromatic amines, first noted in England over 100 years ago. The compounds 2-naphthylamine, 4-aminobiphenyl and benzidine can be found in the products from the chemical, dye and rubber industries as well as in hair dyes, paints, fungicides, cigarette smoke, plastics, metal and motor vehicle exhaust and pollutant emissions from industrial installations.
In 1954, Case et al. reported a 200-fold increased bladder cancer risk for English and Welsh workers exposed to 2-naphthylamine. In the cohort study performed on more than 11 000 workers in the rubber industry, elevated standardised mortality ratios (SMR) for bladder cancer were observed for “storage and shipment” (SMR 253; 95 % CI 93-551) and for “general work” in this industry (SMR 159; 95 % CI 92-279).
4-aminobiphenyl, carcinogenic aromatic amine, present as a carcinogenic component of tobacco smoke is also used in the rubber industry. In a study involving 171 workers in the rubber industry, 19 cases of bladder cancer were observed.
Benzidine, used in dye production and the rubber industry, has been identified as the most important carcinogenic aromatic amine regarding human bladder damage. 92 of 331 workers of one of the most important industrial facilities in Leverkusen, Germany, who had been exposed to benzidine production before 1967, eventually contracted bladder cancer. In a Chinese cohort study, where 784 workers were exposed to benzidine, a 35-fold increased of bladder cancer risk was observed.
Individuals with occupational exposure to hair dyes such as hairdressers and barbers experience enhanced risk of bladder cancer although it is unclear if other lifestyle aspects are responsible for the increase in bladder cancer risk. In a large population-based case-control study in Los Angeles, personal use of hair dyes was assessed according to the types of hair dyes normally used and compared with people who did not use hair dyes. An elevated bladder cancer risk (odds ratio (OR) 1.9; 95 % CI 1.1 -3.3) was claimed for those who used permanent hair dyes at least once a month, for 1 year or longer. The risk increased to 3.3 (95 % CI 1.3 – 8.4) for those who used permanent hair dyes at least once a month for 15 and more years. Hairdressers who performed their jobs for more than 10 years showed a 5-fold increased risk (95 % CI 1.3 – 19.2).
Firefighters exposed to a long list of carcinogens in combustion products including asbestos, polycyclic aromatic hydrocarbons, **benzene**, lead and ***aromatic amines have been shown to be at increased risk of developing a number of cancers including multiple myeloma, non-Hodgkin’s lymphoma, prostate cancer, testicular cancer leukemia, skin cancer, malignant melanoma, brain cancer, and cancer of the rectum, colon, stomach, buccal cavity and pharynx.***
**4,4′-methylenebis(2-chloroaniline) (MBOCA)**
4,4′-methylenebis(2-chloroaniline) (MBOCA) is a synthetic chemical widely used in industry primarily to produce castable polyurethane parts. Most exposure to MBOCA occurs in the workplace; the workers may inhale small particles of MBOCA in the air or absorb MBOCA dust or vapor through the skin. In a Taiwanese study, a total of 70 MBOCA-exposed workers and 92 non-exposed workers were screened for bladder cancer. The study identified a proven bladder carcinoma in MBOCA-manufacturing factories; a worker with suspected malignant cells; and a worker with atypical cytology combined with gross hematuria. The findings of this study support the conclusions from other studies that MBOCA is potentially carcinogenic to humans and control measures (such as issuing work clothing that must not be worn at home; requiring to shower at the end of the work shift; and improving the ventilation system) are needed to prevent overexposure from inhalation and skin absorption.
It has been estimated that the occupational exposures are responsible for 18 % of bladder cancer cases. 2 years’ exposure may be sufficient to increase this risk, but ***the time between exposure and subsequent cancer may be several decades***.
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