Laura Bukavina, MD, and Gabriela Díaz, MD, on the rise of young-onset bladder cancer

In this video, Laura Bukavina, MD, MPH, and Gabriela M. Díaz, MD, discuss new research examining the rising incidence of young-onset bladder cancer and the potential genetic and environmental factors contributing to this trend.¹ Bukavina is a urologic oncologist at Cleveland Clinic, and Díaz is a research fellow at Cleveland Clinic.

For the study, investigators analyzed bladder cancer incidence trends using the TriNetX research network and evaluated inherited genetic variants through the UK Biobank to better understand the factors contributing to young-onset bladder cancer. Díaz explained that although bladder cancer has historically been considered a disease of older men, more recent data indicate a growing burden among younger patients, especially women. Across nearly 300,000 patients identified in TriNetX, bladder cancer incidence increased in all age groups between 2011 and 2023, but the rise was more pronounced among individuals younger than 50 years. Notably, women represented a substantially greater proportion of cases in this younger cohort than expected, suggesting a changing epidemiologic pattern.

The genomic analysis identified several ultra-rare inherited variants associated with young-onset bladder cancer, including alterations in genes such as HERC2, CNTN4, and CACNA2D3. However, Bukavina emphasized that these variants were found in only a handful of patients and therefore do not explain the broader increase in bladder cancer diagnoses among younger adults. Instead, the findings suggest that while inherited genetic predisposition may contribute to disease risk in a small subset of individuals, it is unlikely to be the primary driver of the observed population-level trends.

The investigators believe environmental factors are more likely to account for the increasing incidence of bladder cancer in younger patients. Bukavina noted that although established risk factors such as smoking, asbestos exposure, and occupational chemical exposures remain important, declining smoking rates do not align with the continued rise in bladder cancer cases. She highlighted emerging concerns surrounding newer environmental exposures, including chemicals released during plastics manufacturing and recycling processes, as potential contributors that warrant further study.

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