Original StudyExercise Decreases and Smoking Increases Bladder Cancer Mortality
Introduction
Bladder cancer is the seventh most common cancer in the world and accounts for approximately 50,000 deaths a year in the United States (US) and European Union.1 The US population prevalence is estimated to be at least 600,000 individuals and continues to grow annually.2, 3 Bladder cancer is the fourth most frequently diagnosed cancer among men and—owing to the high costs of diagnosis, treatment, and posttreatment surveillance—the single most expensive cancer to treat.4 These observations underscore the considerable challenges that bladder cancer poses to the public health and highlight an important need to develop innovative, novel therapies.
A potential method of decreasing the morbidity and mortality of bladder cancer is through behavior change interventions focused on modifiable risk factors. Modulation of lifestyle factors—for example, exercise, weight loss, and diet change—may exert beneficial, disease-specific health effects.5, 6, 7, 8 Smoking is strongly associated with increased bladder cancer incidence, and smoking cessation is a potential target for improving outcomes in patients with bladder cancer.9, 10, 11 However, other modifiable risk factors, such as obesity12, 13, 14, 15 and exercise,16, 17, 18, 19 also may play important roles in bladder cancer outcomes. Therefore, we investigated associations of obesity, physical activity, and smoking with bladder cancer mortality in the National Health Information Survey (NHIS).
Section snippets
NHIS
The NHIS is the primary source of information on the United States population conducted by the National Center for Health Statistics as part of the Centers for Disease Control and Prevention. The annual survey provides information regarding illness and disability since the National Health Survey Act of 1956. The NHIS is an annual representative cross-sectional household interview survey of the civilian noninstitutionalized population performed in the US (//www.cdc.gov/nchs/nhis/about_nhis.htm
Results
Complete data were available on 222,163 participants, of whom 96,715 (44%) were men and 146,014 (66%) non-Hispanic whites, and among whom we identified 83 bladder cancer-specific deaths (Table 1). Bladder cancer mortality was noted lowest in those patients who obtained the recommended amount of exercise from the Healthy People 2020 Physical Activity Guidelines as compared with no exercise (0.05%; n = 56 of 116,390 vs. 0.01%; n = 4 of 30,945; P = .006). Figure 1 displays a bar graph for
Discussion
In this study, we observed a 47% decreased risk of bladder cancer death in individuals who reported any form of exercise compared with those who did not exercise. Current and former smokers were 4 and 3 times, respectively, more likely to die of bladder cancer than never-smokers. Therefore, a prospective clinical trial encouraging smoking cessation and physical exercise could provide evidence that behavioral modification may impact bladder cancer outcomes.
Bladder cancer was one of the first
Disclosure
The authors have stated that they have no conflicts of interest.
References (27)
- et al.
Epidemiology and risk factors of urothelial bladder cancer
Eur Urol
(2013) - et al.
A randomized trial of diet in men with early stage prostate cancer on active surveillance: rationale and design of the Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance])
Contemp Clin Trials
(2014) - et al.
Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature
Eur Urol
(2014) - et al.
Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder
J Urol
(2013) - et al.
Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy
Eur Urol
(2013) - et al.
Physical activity and incidence of cancer in diverse populations: a preliminary report
Am J Clin Nutr
(1987) - et al.
Cancer statistics, 2013
CA Cancer J Clin
(2013) - et al.
Cancer treatment and survivorship statistics, 2012
CA Cancer J Clin
(2012) - et al.
The health economics of bladder cancer: a comprehensive review of the published literature
Pharmacoeconomics
(2003) - et al.
Modifiable risk factors for cancer
Br J Cancer
(2004)
A randomized pilot trial of dietary modification for the chemoprevention of noninvasive bladder cancer: the dietary intervention in bladder cancer study
Cancer Prev Res (Phila)
Obesity, physical activity and bladder cancer
Curr Urol Rep
Association between smoking and risk of bladder cancer among men and women
JAMA
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2020, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :In noncancer settings, there is a wealth of observational and randomized trial data demonstrating that exercise and/or diet interventions are associated with improvements in body size metrics [36]. Retrospective studies suggest that physical activity favorably impacts bladder cancer risk and survival outcomes [37]. To date, no prospective trials have evaluated the role of exercise or diet on bladder cancer survival outcomes, however preoperative (prehabilitation) exercise and dietary interventions have shown some promise in improving functional outcomes after surgery [38].
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2018, American Journal of CardiologyCitation Excerpt :There are some smaller studies which also investigated the effect of exercise and smoking on specific cancer types. Their data suggest that exercise and smoking cessation may prevent cancer progression and reduce cancer death.17–19 In conclusion past smokers showed higher rates of obesity, diabetes, hypertension, and low CRF, but mortality was only mildly increased versus never smokers.
Oncologic Effect of Cumulative Smoking Exposure in Patients Treated With Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer
2018, Clinical Genitourinary CancerCitation Excerpt :Smoking is a leading environmental risk factor for several genitourinary cancers.1-4