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American Journal of Epidemiology Advance Access originally published online on January 4, 2007
American Journal of Epidemiology 2007 165(6):660-666; doi:10.1093/aje/kwk047
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American Journal of Epidemiology Copyright © 2007 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

A Prospective Cohort Study of Bladder Cancer Risk in Relation to Active Cigarette Smoking and Household Exposure to Secondhand Cigarette Smoke

Anthony J. Alberg1, Anthony Kouzis1, Jeanine M. Genkinger2, Lisa Gallicchio1, Alyce E. Burke1, Sandra C. Hoffman1, Marie Diener-West3, Kathy J. Helzlsouer1 and George W. Comstock1

1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2 Department of Nutrition, Harvard School of Public Health, Boston, MA
3 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Reprint requests to Dr. Anthony J. Alberg, Department of Biostatics, Bioinformatics, and Epidemiology, Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, P.O. Box 250955, Charleston, SC 29425 (e-mail: alberg{at}musc.edu).

Received for publication December 23, 2005. Accepted for publication July 28, 2006.

Active cigarette smoking is a major risk factor for bladder cancer. Secondhand exposure to cigarette smoke may also contribute to bladder carcinogenesis. The authors conducted a prospective cohort study to examine the influence of both active smoking and household exposure to secondhand smoke (SHS) on subsequent bladder cancer risk. The study population included persons from two cohorts established from private censuses conducted in Washington County, Maryland, in 1963 (n = 45,749; 93 cases) and 1975 (n = 48,172; 172 cases). Poisson regression models were fitted to estimate the relative risk of bladder cancer associated with active and passive smoke exposure in the two cohorts (referent category: never smokers who did not live with any smokers). Current smokers had an elevated risk of bladder cancer in both the 1963 cohort (relative risk (RR) = 2.7, 95% confidence limits (CL): 1.6, 4.7) and the 1975 cohort (RR = 2.6, 95% CL: 1.7, 3.9) after adjustment for age, education, and marital status. Among nonsmoking women, current household SHS exposure was associated with bladder cancer risk in the 1963 cohort (RR = 2.3, 95% CL: 1.0, 5.4) but not in the 1975 cohort (RR = 0.9, 95% CL: 0.4, 2.3). This study further solidifies the evidence that active smoking is causally associated with bladder cancer. Additional studies are needed to determine whether passive smoking is a risk factor for bladder cancer.

bladder neoplasms; risk factors; smoking; tobacco smoke pollution

Abbreviations: CL, confidence limits; RR, relative risk


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