It is well documented that the etiology of bladder cancer involves environmental risk factors. Occupational risks may account for 21-27% of bladder cancers among men in the United States, an estimated 40,000 cases in 2001, and 11% among the estimated 15,000 cases in women in 2001. Occupational exposure to aromatic amines has been known to cause bladder cancer since Rehn identified the first few cases in workers in the new organic chemical industry in 1895. Since that time, numerous occupations and specific substances have been associated with an increased risk of bladder cancer (Tables 30.3.1 and 30.3.2). Beyond the certainties that specific aromatic amines have been demonstrated to be human occupational bladder carcinogens and that a broad range of occupations are at risk of bladder cancer, a well-informed approach to the prevention and management of bladder cancer depends on appreciating various controversies involved in its primary and secondary prevention and treatment. The reader is referred to a report of a national conference held in 1989 to delineate these issues. Many of these controversies, such as the relevance to human bladder cancer of findings from animal studies, the line between benign and malignant tumors, the appropriate screening regimen for workers exposed to bladder carcinogens, and whether early detection is worthwhile, remain relevant more than a decade later. In addition to incidence and survival differences by social class, race, and gender, new developments in understanding inherited risk factors, such as acetylator status and intermediate biomarkers, influence understanding of etiology, prevention and management.
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