Prevention

Smoking-Related Bladder Cancer Burden Remains High

Smoking remains one of the most important preventable risk factors for bladder cancer, and new global data illustrate how substantial its impact continues to be. An analysis of the Global Burden of Disease 2021 study examined smoking-attributable urologic cancers among adults aged 40 years and older across 204 countries and territories. Among the three cancers evaluated, bladder cancer accounted for the largest smoking-attributable disease burden in 2021, highlighting the continued relevance of smoking history and cessation in bladder cancer prevention and care.

The investigators analyzed deaths, disability-adjusted life years (DALYs), age-standardized mortality rates, and age-standardized DALY rates from 1990 through 2021. During that period, the age-standardized burden associated with smoking-attributable bladder cancer declined globally. The age-standardized DALY rate fell from 71.48 per 100,000 in 1990 to 42.43 per 100,000 in 2021, while the age-standardized mortality rate declined from 3.36 to 2.08 per 100,000. Despite those improvements, the absolute burden moved in the opposite direction.

Smoking-attributable bladder cancer DALYs increased from approximately 931,000 in 1990 to more than 1.22 million in 2021, while deaths increased from approximately 40,900 to 58,600. Age also played an important role. In 2021, the greatest number of bladder cancer DALYs occurred among adults aged 70 to 74, while the highest DALY and mortality rates were observed among those aged 90 to 94. These findings illustrate how population growth and aging can increase the overall number of patients affected even as age-standardized rates decline.

Considerable geographic variation was also observed. Age-standardized bladder cancer DALY and mortality rates declined across all five sociodemographic index groups, but the burden remained unevenly distributed around the world. By 2021, East Asia had the greatest absolute number of bladder cancer DALYs, while Central Europe had the highest age-standardized DALY rate among the 21 regions examined. At the national level, substantial differences persisted across the 204 countries and territories included in the analysis.

Looking ahead, researchers projected that age-standardized DALY and mortality rates for smoking-attributable bladder cancer will continue to decline through 2045. However, the absolute numbers of deaths and DALYs are expected to increase, reinforcing the continuing clinical and public health impact of tobacco exposure. For urologists, the findings provide another reminder that smoking history remains highly relevant in bladder cancer and that declining population-level rates do not necessarily translate into a smaller number of patients affected. The authors also caution that the analysis relied on modeled Global Burden of Disease estimates and that projections through 2045 should be interpreted as scenarios rather than fixed predictions.