Preventing occupational disease and injury. Weeks JL, Levy BS, Wagner GR, eds. Washington, DC: American Public Health Association, 1991 Jan; :161-164
Bladder cancer as an occupational disease was discussed. Included were clinical symptoms, diagnosis, occurrence, and causes of bladder cancer. Also discussed were the pathophysiology and prevention of bladder cancer. Clinical symptoms of bladder cancer included microscopic or gross hematuria, change in the time and frequency of urination, and pain. Diagnosis may be confirmed by cystoscopy and biopsy. The incidence of bladder cancer has been rising, while mortality has been declining. It is more common in men than in women (2.5 to 3.0 times) and twice as common in whites than in nonwhites. About 30% to 40% have been found to be caused by cigarette smoking, and 10% to 50% by occupational exposure. There is an occupational association between bladder cancer and aromatic amines, including beta-naphthylamine (91598) and 4,4'-methylenebis(2- chloroaniline) (101144). An association also exists with polycyclic aromatic hydrocarbons. There is a 4 to 40 year latency from first exposure. Prevention involves substituting noncarcinogens for carcinogens, using ventilation, avoiding risk factors such as smoking, and surveillance of effects and exposures. Worker education, and medical screening are uncertain in value in finding early lesions. Risk may be increased for those with recessive trait for the liver bound N-acetyltransferase and with phenotypes of the ability to hydroxylate debrisoquine.