By Dr. Jay Shah and Maura Livengood 

While most people know that cigarette smoking is the No. 1 risk factor for lung cancer, few realize that it is the single biggest risk factor for bladder cancer as well.

Bladder cancer is the fifth most common cancer in Americans and the most common cancer of the urinary tract. But it is largely out of the public eye, even though nearly 71,000 new cases of bladder cancer are diagnosed each year in the United States alone.

Smokers have a 400 percent greater chance of developing bladder cancer than nonsmokers. Unfortunately, most people don’t learn that until after they develop it. The connection between smoking and bladder cancer lies in the fact that the toxic chemicals in the smoke pass into the urine where they can damage the lining of the bladder.

Certain occupations with exposures to chemicals can also place workers at an increased risk for bladder cancer. Dry cleaners, hairdressers, printers, painters, truck drivers, machinists and rubber, chemical, leather, textile and metal workers are in at-risk occupations.

Other factors that are more difficult to control include chronic bladder irritation, repeated bladder infections, long-term catheter use, previous chemotherapy with the drug cyclophosphamide, previous radiation to the pelvis, and ingestion of arsenic through a contaminated water supply. Some factors are completely out of your control, such as a prior history of bladder cancer, advancing age and being white and male.

Routine screening is recommended only for those with risk factors. By far, the most common symptom is blood in the urine, which may be seen by the naked eye or may only be detected with laboratory testing. Unfortunately, many patients with blood in their urine put off seeing a doctor because it is almost always painless.

Bladder cancer is diagnosed using a procedure called a cystoscopy, which allows the physician to look inside the bladder and take samples of any suspicious areas. Urine tests that look for cancer cells, a CT scan, and a specialized X-ray taken after a dye is injected into a vein may also be part of the work-up. After the diagnosis is confirmed, additional tests are performed to see if the cancer has spread outside the bladder. These tests help predict how aggressive the cancer is and allow for selecting the proper treatment options, which range from scraping the cancer cells during cystoscopy to complete removal of the bladder, or chemotherapy.

We are investigating the quality of bladder cancer care in Texas through the Comparative Effectiveness Research on Cancer in Texas project. This interdisciplinary group of researchers is investigating important questions about cancer screening and the quality of treatment, follow up and ongoing supportive care for cancer patients and survivors in Texas.

The consortium includes researchers from the University of Texas Medical Branch, the University of Texas MD Anderson Cancer Center, the University of Texas School of Public Health, Rice University, Baylor College of Medicine and the Texas Cancer Registry.

It’s important for Texans to understand that prevention and early detection are key to combating bladder cancer. Please take steps to reduce the risk factors you have control over. If you’re a smoker, you now have one more reason why you should quit.

Dr. Jay Shah is assistant professor of urology at the University of Texas MD Anderson Cancer Center and a co-investigator with the CERCIT consortium. Maura Livengood is a fourth-year medical student at the University of Texas Medical School at Houston who is currently preparing for a urology residency.