Tobacco.org

• EDITORIAL: Cigarette Smoking and Bladder Cancer: A New Twist in an Old Saga?  

So far, the changing carcinogenic properties of cigarettes have been studied most extensively for lung cancer, and it is known that this risk has increased over time (13). Furthermore, the relative risks of mortality from "other smoking-related cancers" increased for both men (RR = 2.7 to 3.5) and women (RR = 1.8 to 2.6) when a cohort established in 1959, with follow-up through 1965, and another cohort established in 1982, with follow-up through 1988, were compared (14). In cohort studies carried out in the United States, that reported the RR for current smokers relative to nonsmokers in relation to bladder cancer incidence. No increase in the association was observed in successive and overlapping cohorts in Washington County, Maryland (RR = 2.7 for bladder cancer incidence in current smokers relative to nonsmokers in the first cohort, followed from 1963 to 1988; RR = 2.6 in the second cohort, followed from 1975 to 1994) (15). A similar relative risk (RR = 2.9) was reported in a Hawaiian cohort followed from 1966 to 1988 (16). In a few recent cohort studies, reported RRs of bladder cancer incidence among current smokers relative to nonsmokers were notably higher: 5.7 in Seventh Day Adventists followed from 1976 to 1982 (17) and 5.5 in the Iowa Women's Health Study cohort followed from 1986 to 1998 (18). This evidence is equivocal but certainly does not rule out that the association has grown stronger over time.

The findings of Baris et al. (7) are provocative and are accompanied by a tenable hypothesis. Recalling the steady accumulation of evidence and the cautious inferences that eventually led to the determination that smoking causes bladder cancer, these intriguing findings offer a testable hypothesis that warrants thorough investigation. An important element of this research will be to more precisely, pinpoint the specific role of cigarette additives will be an important element of this research. This study highlights the need for continued vigilance in monitoring the impact of changing cigarette content and design on disease risk, and demonstrates that the public health implications of the changing cigarette content and design are potentially severe.

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