Study shows low public awareness of smoking as a risk factor for bladder cancer

Bladder Cancer

Bladder Cancer

Findings from the phase 3 FinnBladder 9 trial published in European Urology Focus suggest that public knowledge of the increased risk of bladder cancer due to smoking is low, highlighting the need to raise awareness through more publicity and education.1

In a baseline survey, 44% of patients were unsure if smoking was a risk factor for bladder cancer. At the 12-month follow-up, awareness that smoking cessation decreased bladder cancer risk increased from 82% to 92% with the fact that smoking cessation can cause bladder cancer recurrence (P = .038). Additionally, older patients had significantly less knowledge of the association between smoking and bladder cancer recurrence, progression, and mortality.

“Bladder cancer survivors’ awareness of smoking-related risk factors should serve as a basis for prevention initiatives. In this prospective study, we demonstrated that patients’ awareness of smoking as a risk factor for bladder cancer is lower than for other smoking-related medical conditions such as lung cancer and coronary heart disease. Our study relied on the undetermined fact that smoking cessation reduces the risk of disease recurrence and progression and cancer-specific mortality,” the investigators of the study wrote.

A total of 411 patients were enrolled on the study (NCT01675219), 41 of whom did not complete the baseline questionnaire. Three hundred and seventy patients were included in the analysis. A total of 71% of patients completed questionnaires on smoking-related bladder cancer risk, 73% on bladder cancer recurrence, 72% on bladder cancer progression, and 72% on bladder cancer death.

The majority of patients were men (83%), with a mean age of 70 years. Investigators reported that 62% of patients had primary tumors and 51% had low-grade tumors. Eighty one percent of patients also had non-muscle invasive tumors and 13% had no cancer even with clinical suspicion at the time of randomization.

At baseline, 59% of patients were former smokers, 19% were current smokers, and at the 12-month follow-up, 16% were still smoking (P = .54). The median smoking duration for ever-smokers was 20 years. Among smokers, 65% were interested in smoking cessation with a median of 4 prior cessation attempts. During the 12-month follow-up there was no significant interest or changes in smoking cessation.

Additional findings indicated that at baseline, 56% of patients stated that smoking was a definitive risk factor for bladder cancer vs 58% at 12 months. Responding proportions for lung cancer, coronary artery disease, stroke, and asthma were 93%, 80%, 73%, and 69%, respectively. There were no significant changes after 12 months of follow-up.

The recurrence of bladder cancer (OR, 0.33; 95% CI, 0.15-0.71; P = .005), and older age (OR, 0.45; 95% CI, 0.21-0.96; P = .039) were associated with less knowledge of bladder cancer and recurrence. Age (OR, 0.36; 95% CI, 0.15-0.81; P = .013) and previous bladder cancer recurrence (OR, 0.27; 95% CI, 0.11-0.61; P = .002) impacted knowledge of bladder cancer-specific mortality.


1. Sell V, Ettala O, Perez IM, et al. Awareness of Smoking as a risk factor in bladder cancer: results from the prospective FinnBladder 9 trial. Eur Urol Focus. Published Online January 27, 2022. doi:10.1016/j.euf.2022.01.012

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