Is there anything I can do to prevent bladder cancer?

The number one thing that you can do to prevent bladder cancer is to stop smoking.  Do not pick up a cigarette if you have never smoked, and also avoid secondary smoke exposure as best as you can. There are some patients, and I have had patients who have worked in the chemical industries, where there is a known risk of bladder cancer - so they use protective masks, protective clothing, and have regular check-ups. There is no clear-cut dietary supplement that can prevent the development of bladder cancer.

Does smoking increase my risk of developing bladder cancer?

If there is one risk factor that has been unequivocally worldwide demonstrated to be a risk for bladder cancer, it is smoking. Smoking increases the risk of developing bladder cancer in both men and women (in all races fourfold), so the answer is a clear yes. The number one cause of bladder cancer for patients with who we can identify a cause is smoking related.

Does second hand smoke cause bladder cancer?

There is not clear data on secondhand smoke, but certainly the evidence on firsthand smoke is so compelling and overwhelming, that it is the recommendation of most urologists and cancer specialists to avoid secondhand smoke. This is not just for the bladder cancer benefits, but for the associated pulmonary complications such as emphysema, bronchitis and lung cancer.

Can nutrition help prevent bladder cancer?

There is a lot of interest in looking at nutritional and holistic approaches to preventing and treating bladder cancer. I'm not aware of any well-designed, documented studies showing any clear-cut evidence that dietary changes or modifications will have a huge impact on the risk of developing bladder cancer. Certain vitamins have been looked at, and vitamin complexes have been looked at. Licopenes have been looked at. Triptophan metabolites have also been looked at, and it has been suggested that there may be a causal relationship. As of today, however, we don't have any clear-cut evidence or dietary recommendations that we mend.

Is there a connection between early menopause and bladder cancer?

There is data to suggest that women who have a menopause before age 42 do have an increased risk of bladder cancer, and that's whether it's a natural menopause or a surgically induced menopause following hysterectomy. Broad-based populational studies seem to hold that evidence up. The hazard ratio is not huge; it's somewhere around 1.15% to 1.2%, but there tends to be a hormonal component. Interestingly, one of the aspects of bladder cancer in men that's being looked at, is the role of testosterone in aging males with declining testosterone. Does that put them at a greater risk? There may be some hormonal risk that's unrecognized right now for both genders.

What is the connection between catheters and bladder cancer?

There is a strong association between chronic, long-term catheterization, as seen in quadriplegics or paraplegics, and the subsequent development of bladder cancer. The type of bladder cancer that chronic inflammation and irritation (such as is associated with catheters or bladder stones) leads to is called squamous cell carcinoma. It's a little different than the common variety or the more common variety of transitional cell carcinoma. Interestingly, inflammation and chronic infection with parasites in other parts of the world, notably the Nile Valley in Egypt, North Africa, leads to parasitic infestation and inflammation of the bladder called Schistosomiasis, and this very frequently leads to bladder cancer. Again, it's the squamous cell variant, which is mostly coming out of Egypt and North Africa. Somewhere between 30% and 50% of patients who have squamous cell carcinoma in that part of the world, when the tumor is studied, is found to contain various strains of HPV virus, human papillomavirus, which in this country has been clearly associated with cervical cancer in women. There may be a viral component that we don't understand, that we don't see in this part of the world. Again, it raises the question of the role of chronic irritation and inflammation.

Does hair dye cause bladder cancer?

There have been several reports of women with long term exposure to hair dyes being at a high risk for bladder cancer. The data certainly isn't clear on that, and there are just as many reports suggesting that there is an association, as those that there aren't. The largest piece of evidence is a Meta analysis which was published in JAMA two years ago. The conclusion of that article was that there is not enough evidence to support the association between hair dyes and the subsequent development of bladder cancer. In the original reports, women who dyed their hair on an average of once a month for five years, had two tenths of a percent higher risk of developing bladder cancer. That figure went to four tenths of a percent over 15 years. When you look at the actual numbers, although the risk seems to be high, the numbers themselves are low. The risk was higher in women who used darker shades (the dark browns, deep blacks and reds) than in the women who used the lighter hair tinting. However, there is no conclusive evidence right now to suggest there is a cause or relationship.

What kinds of hair dye cause bladder cancer?

In hair dye, there is what is referred to as shade. It is the amount of shade in that dye that leads to development, so the darker shades have more of the shade chemicals in them. In the studies that report an association, it is reported higher in women who use the darker shades versus lighter tinting.

Why do urologists recommend people drink lots of water?

Urologists recommend drinking water for a number of reasons. Bladder cancer is one of them, but it's at the bottom of the list. In sexually active women, we encourage lots of water to help flush out any bacteria that may get introduced into the bladder, as a preventive measure. Your kidneys are dependant on a good state of hydration. If you're not well hydrated, your kidneys shut down. If you go without water for a long period of time, they can actually shut down temporarily, but generally do recover. As a urologist, we see the benefits of hydration from the kidneys to the bladder and out. Urologists recommend 8-10 glasses of water a day.

Can tap water cause bladder cancer?

Issues surrounding tap water or municipal drinking water have been looked at in a number of population-based surveys. Some have been better controlled than others, and there is conflicting data. There is data to suggest two sources of carcinogens or potential problems within the drinking water. One is chlorinated water - chlorine metabolites have been associated, depending on the amount of chlorine in the water, to suggest that there may be a very slight increase in the hazard ratio, or the risk of developing lifetime bladder cancer. The other has involved nitrite content within the water, though the data is conflicting. The data from Iowa that suggested that the nitrate levels in water increased a woman's risk of developing bladder cancer, but at the same time showed that it reduced the risk of uterine cancer, cervical cancer, and colorectal cancer. It's a little bit unclear. The chlorine data also showed that there was an increased associated risk of brain cancer with higher chlorine levels, although that's never been substantiated.

Right now, there is certainly no clear cut evidence to suggest that we should stop drinking tap water. In fact, there is evidence that water consumption itself is protective. As in the case of a bladder infection where you want to flush out the bacteria, you want to flush out the carcinogens if there are any in the bladder, and by maintaining good hydration, frequent urination, large volume urination, it has been shown to decrease the risk of bladder cancer.