Cancer Research UK on Google+ Cancer Research UK on Facebook Cancer Research UK on Twitter

Bladder cancer risk factors

This page presents information on the risk factors for bladder cancer including by tobacco, occupation exposure, hair dyes, medicines and medical conditions, hormonal factors, family history and food and drink. Overall, it has been estimated that, in the UK, around 44% of bladder cancer cases in men and 37% in women are linked to lifestyle and environmental factors. The proportion is higher in men than women due to higher rates of smoking in men in the past, and higher exposure to occupational hazards among men.1




Smoking cigarettes is the principal preventable risk factor for bladder cancer in both men and women. A study published in December 2011 estimated that 38% of bladder cancer cases in men and 34% in women in the UK in 2010 were caused by smoking.2

Current smokers have up to four times higher bladder cancer risk compared with never-smokers, a cohort study of people aged 50 and over showed,75 with the highest risks for people smoking for the longest, or smoking a greater amount of cigarettes each day.70-71

Smoking cessation reduces risk, but risk in ex-smokers remains higher than never-smokers for more than 20 years.70-71

Environmental tobacco smoke

In a recent European study, exposure to environmental tobacco smoke (ETS) during childhood increased the risk of bladder cancer by almost 40%.4 However, the body of evidence does not support a link between ETS exposure in adults and bladder cancer risk.49 A record linkage study of bladder cancer incidence in the offspring of men and women diagnosed with lung cancer found a significant increase in risk of bladder cancer in those whose mothers had lung cancer, but no increased risk for paternal lung cancer. The authors interpreted this as evidence that exposure to tobacco carcinogens in utero or while breastfeeding may lead to bladder cancer in later life.5

Smoking cessation after diagnosis may favourably alter the course of the disease but the evidence is incomplete.6 It has also been suggested that high fruit consumption may reduce the effect of smoking on developing bladder cancer.7

The precise mechanism by which cigarette smoking induces bladder cancer is unclear. Studies show that risk varies by type of tobacco, with a higher risk for black ‘air-cured’ than blond ‘flue-cured’ tobacco.8 Smokers of black tobacco have higher reported levels of aromatic amines in their urine than smokers of blond tobacco.9 These aromatic amines are known urothelial carcinogens and the ability to detoxify them is compromised in people who are ‘slow acetylators’ and it is suggested that these people are at higher risk than ‘fast acetylators’ (see Molecular biology and genetics section).10

Tobacco tars have been shown to induce bladder papillomas and carcinomas in mice.11 It is thought that prolonged exposure of the bladder to such urinary carcinogens during the excretory process may lead to the development of bladder cancer.

section reviewed 01/03/06
section updated 01/03/06


Occupational exposures

It has been estimated that, in the UK, around 7% of bladder cancer cases in men and 2% in women are linked to occupational exposures.64,68 This proportion may be higher in countries with less-regulated industrial processes.

Aromatic amines

In 1895 Rehn reported cases of bladder cancer in a German aniline dye factory.12 This led to occupational studies in other countries but it was not until the 1950s that the risk from aromatic amines, particularly benzidine and a-and ß-naphthylamine, was established by Case.13

Aromatic amines were widely used in the manufacture of dyes and pigments for textiles, paints, plastics, paper and hair dyes, in drugs, pesticides and as antioxidants in the rubber industry.14 Production of ß-naphthylamine ceased in the UK in 1952 (its use was withdrawn from the rubber and cable industry prior to this in 1949)15 and in 1953 bladder cancer became, and still is, a prescribed industrial disease.16

Polycyclic aromatic hydrocarbons (PAH)

Exposure to polycyclic aromatic hydrocarbons (PAH), which are by-products of combustion processes and therefore present in a range of industries, has also been investigated. It is calculated that about 4% of bladder cancer cases in European men are due to exposure to PAH.17 A recent meta-analysis showed a risk increase of about 30% for bladder cancer in painters and the International Agency for Research on Cancer classifies occupation as a painter as a cause of bladder cancer.66,69

Diesel engine exhaust

In June 2012, IARC classified diesel exhaust as associated with an increased risk of bladder cancer. This was based on limited evidence mainly from studies of highly-exposed workers.72

section reviewed 01/03/06
section updated 01/03/06

Hair dye

The International Agency for Research on Cancer (IARC) classifies working as a hairdresser or barber as a probable cause of bladder cancer, based on limited evidence; this is mainly linked with exposure to chemicals in hair dyes.88,89 Bladder cancer risk is 30-35% higher in hairdressers compared with the general public, meta-analyses have shown; however it remains unclear whether this is limited to hairdressers working before some carcinogenic chemicals were banned from hair dyes in the 1970s.90,91 This is distinct from domestic personal hair dye use.

section reviewed 04/04/14
section updated 04/04/14

Previous cancer

Bladder cancer risk is higher in survivors of larynx and lung cancers (males and females); and head and neck, prostate, and kidney cancers (males), a cohort study in France showed.105

Bladder cancer risk is higher in male survivors of prostate, head and neck, and lung cancers (males), with no association with previous cancer in females, a cohort study in Australia showed.106

Genitourinary cancer risk is 1.7-2.7 times higher in children, teenagers and young adults who had any type of cancer in childhood, compared with the general population, a cohort study showed.109

section reviewed 21/05/14
section updated 21/05/14

Ionising radiation

A very small proportion of bladder cancer cases are associated with therapeutic irradiation in the pelvic region, for example for testicular cancer21 or cervical cancer.22 Men with a history of prostate cancer, both those treated with and without radiotherapy, have an increased risk of bladder cancer.23-25 The risk of bladder cancer has been shown to be increased two-fold in women treated for cervical cancer without radiotherapy, which may be due to shared risk factors such as smoking. A risk increase was also seen in women treated with radiotherapy- the risk was almost six-fold for women treated for cervical cancer 40 or more years previously.50

A study published in December 2011 has estimated that 2.6% of bladder cancer cases in men and 2.3% in women in the UK in 2010 were linked to radiation exposure, with most of these cases linked to exposure to diagnostic radiation.67

section reviewed 01/03/06
section updated 01/03/06


Medical conditions and treatments


In addition to aromatic amines, there are other established bladder carcinogens including phenacetin and certain cancer chemotherapeutic agents including cyclophosphamide.19,20


Paraplegics have a greatly increased risk of squamous cell carcinomas of the bladder, due to their disposition to chronic urinary tract infection. Kidney and urinary stones may also slightly increase risk.26

Gastric ulcers

There is limited evidence that a history of gastric ulcer increases risk.30,31

section reviewed 01/03/06
section updated 01/03/06


The risk of bladder cancer is up to around a third higher in diabetics than non-diabetics, meta-analyses have shown.76-79,86 Diabetes treatment is likely to explain much of this increased risk, though treatment type often relates to diabetes stage, which may further confound findings, and detection bias may play a part.108

Bladder cancer risk is around 20% higher in diabetics using pioglitazone compared with diabetic non-users, meta-analyses of observational studies have shown; meta-analysis of randomised controlled trials indicates a stronger risk increase.80-82,87 Bladder cancer risk among diabetics is not associated with use of rosiglitazone, meta-analyses have shown.80-82,87 Bladder cancer risk among diabetics may be slightly lower in insulin users compared with non-users, meta-analyses have shown, though evidence remains mixed.95,96 Bladder cancer risk among diabetics is not associated with metformin use, a meta-analysis has shown.104

section reviewed 11/08/14
section updated 11/08/14


Human papillomavirus (HPV)

One study showed a doubling in risk of bladder cancer in patients with condylomata acuminata (genital warts).60 Genital warts are caused by infection with the human papillomavirus (HPV), and a meta-analysis showed a three-fold increased risk associated with HPV infection.61

section reviewed 01/03/06
section updated 01/03/06


Schistosomiasis is a parasitic infection that occurs throughout Africa and the Middle East. One form of the parasite, schistosoma haematobium, is linked to bladder cancer and was estimated to cause around 10,600 cases of the disease worldwide in 2002.65

section reviewed 01/03/06
section updated 01/03/06

Immune system

Organ transplant

Bladder cancer risk is around threefold higher among renal transplant recipients, compared with the general public, a meta-analysis showed.100

section reviewed 01/05/14
section updated 01/05/14


Reproductive factors

Women who have given birth at least once have a 27-31% lower risk of bladder cancer compared with those who have never given birth, meta-analyses have shown.83,84 The link is stronger in never-smokers than ever-smokers.84 Women who had early menopause (younger than 43-49) have a 49% increased bladder cancer risk compared with those who had menopause later, though being post-menopausal is not in itself associated with risk.83 Late age at menarche (older than 15) was associated with 43% decreased bladder cancer risk in a large US cohort study.85 Links with hormone replacement therapy (HRT) use remain unclear, while use of oral contraceptives is not associated with risk increase.83-85

section reviewed 05/12/13
section updated 05/12/13


Family history and genetic conditions

Most studies show between two and six times the risk of bladder cancer in first-degree relatives of bladder cancer patients, with a higher risk if the relative was diagnosed before the age of 45.53-55

section reviewed 01/03/06
section updated 01/03/06



Higher intake of fruit has been associated with a small but significant reduction in the risk of bladder cancer. An increase in fruit consumption of 100 grams a day is estimated to reduce risk by approximately 20%.32-34 However, some studies have shown no association with fruit intake and it is not possible to say there is a definite protective association.56-58

Two Chinese cohort studies have reported a significant increase in risk with higher consumption of soya foods.35,36 This association is not clearly understood: one theory is that the chemical reaction of chlorine in water with humic substances in beans during fermentation may act as a bladder carcinogen.

Results of a pooled analysis of 10 European studies show that heavy coffee consumption (more than 10 cups per day) is associated with a significantly increased risk of bladder cancer in men and women37 but there is no evidence of risk increase with moderate consumption.38,39

section reviewed 01/03/06
section updated 01/03/06

Bladder cancer risk is not associated with total fluid intake, cohort studies have shown.101-103 Case-control studies have returned inconsistent results,41,59,62,102 with possible effect moderation by smoking,103 and urination frequency.63

Bladder cancer risk may be higher in people who drink the most tap water, meta-analyses have shown;41,42 the association may reflect the effect of chlorination, and may apply to males only.41-43

section reviewed 01/05/14
section updated 01/05/14

Bladder cancer risk may be slightly decreased (27%) in people with a high-folate diet, however this effect is limited to case-control studies.93

section reviewed 04/04/14
section updated 04/04/14


Exposure to arsenic and inorganic arsenic compounds is classified by IARC as a cause of bladder cancer.97

Bladder cancer risk is only increased with high level, long-term arsenic exposure.98 Bladder cancer risk is not increased at lower-dose arsenic exposure, a meta-analysis showed.99

section reviewed 22/04/14
section updated 22/04/14

Factors shown to decrease or have no effect on bladder cancer risk


Bladder cancer risk is 15% lower in the most physically active people, compared with the least, a meta-analysis showed.107

section reviewed 26/06/14
section updated 26/06/14

No effect

Bladder cancer risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Personal hair dye use.92
  • Systemic lupus erythematosus.94

section reviewed 14/04/14
section updated 14/04/14

No Error

Rate this page:
Submit rating
Rate this page
Rate this page for no comments box
Please enter feedback to continue submitting
Send feedback
Question about cancer? Contact our information nurse team

Visit our A-Z topic pages


References for bladder cancer risk factors

  1. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Br J Cancer 2011; 105 (S2):S77-S81; doi: 10.1038/bjc.2011.489.
  2. Parkin DM. Tobacco-attributable cancer burden in the UK in 2010. Br J Cancer, 6 Dec 2011; 105 (S2):S6-S13; doi: 10.1038/bjc.2011.475.
  3. NICE. Guidance on Cancer Services. Improving Outcome in Urological Cancers. National Institute for Clinical Excellence, 2002.
  4. Bjerregaard BK, Raaschou-Nielsen O, Sørensen M, et al. Tobacco smoke and bladder cancer-in the European prospective investigation into cancer and nutrition. Int J Cancer 2006;119(10):2412-6.
  5. Hemminki K and B Chen. Parental lung cancer as predictor of cancer risks in offspring: clues about multiple routes of harmful influence? Int J Cancer 2006; 118(3): p. 744-8.
  6. Aveyard P, Adab P, Cheng KK, et al. Does smoking status influence the prognosis of bladder cancer? A systematic review. BJU Int 2002; 90(3):228-39.
  7. Kellen E, Zeegers M, Paulussen A, et al. Fruit consumption reduces the effect of smoking on bladder cancer risk. The Belgian case control study on bladder cancer. Int J Cancer 2006; 118(10):2572-8.
  8. Samanic C, Kogevinas M, Dosemeci M, et al. Smoking and bladder cancer in Spain: effects of tobacco type, timing, environmental tobacco smoke, and gender. Cancer Epidemiol Biomarkers Prev 2006; 15(7):1348-54.
  9. Malaveille C, Vineis P, Estéve J, et al. Levels of mutagens in the urine of smokers of black and blond tobacco correlate with their risk of bladder cancer. Carcinogenesis 1989; 10(3): p. 577-86.
  10. Marcus PM, Hayes RB, Vineis P, et al. Cigarette smoking, N-acetyltransferase 2 acetylation status, and bladder cancer risk: a case-series meta-analysis of a gene-environment interaction. Cancer Epidemiol Biomarkers Prev 2000; 9(5):461-7.
  11. Ross RK, PA Jones, and MC Yu. Bladder cancer epidemiology and pathogenesis. Semin Oncol 1996; 23(5):536-45.
  12. Rehn L, Blasengeschuwulste bei Fuchsin-Arbeitern. Arch Klin Chir, 1895. 50:588-600.
  13. Case RA and Pearson JT.Tumours of the urinary bladder in workmen engaged in the manufacture and use of certain dyestuff intermediates in the British chemical industry. Br J Ind Med 1954; 11:75-104.
  14. Tomatis L (ed). Cancer: Causes, Occurrence and Control. Vol. 1992, Lyon: IARC Scientific Publication No 120.
  15. Veys C.ABC of Work Related Disorders: Occupational Cancers. BMJ 1996; 313:615-619.
  16. Occupational bladder cancer: a guide for clinicians. The BAUS Subcommittee on Industrial Bladder Cancer. Br J Urol 1988; 61(3):183-91.
  17. Kogevinas M, 't Mannetje A, Cordier S, et al.Occupation and bladder cancer among men in Western Europe. Cancer Causes Control 2003; 14(10):907-14.
  18.  Czene K, Tiikkaja S, and Hemminki K. Cancer risks in hairdressers: Assessment of carcinogenicity of hair dyes and gels. Int J Cancer 2003; 105(1): p. 108-12.
  19. Bosetti C, Gallus S, and La Vecchia C. Aspirin and cancer risk: an updated quantitative review to 2005. Cancer Causes Control 2006; 17(7):871-88.
  20.  Travis LB, Curtis RE, Glimelius B, et al. Bladder and kidney cancer following cyclophosphamide therapy for non-Hodgkin's lymphoma. J Natl Cancer Inst 1995; 87(7):524-30.
  21. Travis LB, Fosså SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 2005; 97(18):1354-65.
  22. Boice JD, Engholm G, Kleinerman RA, et al., Radiation dose and second cancer risk in patients treated for cancer of the cervix. Radiat Res 1988; 116(1):3-55.
  23. Brenner DJ, Curtis RE, Hall EJ, et al. Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer 2000; 88(2):398-406.
  24. Singh A, Kinoshita Y, Rovito PM Jr, et al. Higher than expected association of clinical prostate and bladder cancers. J Urol 2005; 173(5):1526-9.
  25. Chrouser K, Leibovich B, Bergstralh E, et al.Bladder cancer risk following primary and adjuvant external beam radiation for prostate cancer. J Urol 2005; 174(1):107-11.
  26. Shokeir AA. Squamous cell carcinoma of the bladder: pathology, diagnosis and treatment. BJU Int 2004; 93(2):216-20.
  27. Tripathi A, Folsom AR, and Anderson KE. Risk factors for urinary bladder carcinoma in postmenopausal women. The Iowa Women's Health Study. Cancer 2002; 95(11):2316-23.
  28. Ng Y., Husain I, and Waterfall N. Diabetes mellitus and bladder cancer--an epidemiological relationship?. Pathol Oncol Res 2003; 9(1):30-1.
  29. Coughlin SS, Calle EE, Teras LR, et al.Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. Am J Epidemiol 2004; 159(12):1160-7.
  30. Michaud DS, Mysliwiec PA, Aldoori W, et al.Peptic ulcer disease and the risk of bladder cancer in a prospective study of male health professionals. Cancer Epidemiol Biomarkers Prev 2004; 13(2):250-4.
  31. Pelucchi C, Negri E, Talamini R, et al. Gastric and duodenal ulcer and risk of bladder cancer. Cancer Epidemiol Biomarkers Prev 2005; 14(2):550.
  32. Riboli E and T Norat. Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr 2003; 78(3 Suppl):559S-569S.
  33. Steinmaus CM, Nunez S, and Smith AH. Diet and bladder cancer: a meta-analysis of six dietary variables. Am J Epidemiol 2000; 151(7):693-702.
  34. Zeegers MP, Kellen E, Buntinx F, et al. The association between smoking, beverage consumption, diet and bladder cancer: a systematic literature review. World J Urol 2004; 21(6):392-401.
  35. Sun CL, Yuan JM, Wang XL, et al. Dietary soy and increased risk of bladder cancer: a prospective cohort study of men in Shanghai, China. Int J Cancer 2004; 112(2):319-23.
  36. Sun CL, Yuan JM, Arakawa K, et al., Dietary soy and increased risk of bladder cancer: the Singapore Chinese Health Study. Cancer Epidemiol Biomarkers Prev 2002; 11(12):1674-7.
  37. Sala M, Cordier S, Chang-Claude J, et al. Coffee consumption and bladder cancer in nonsmokers: a pooled analysis of case-control studies in European countries. Cancer Causes Control 2000; 11(10):925-31.
  38. Zeegers MP, Dorant E, Goldbohm RA, et al. Are coffee, tea, and total fluid consumption associated with bladder cancer risk? Results from the Netherlands Cohort Study. Cancer Causes Control 2001; 12(3):231-8.
  39. Tavani A and La Vecchia C. Coffee and cancer: a review of epidemiological studies, 1990-1999. Eur J Cancer Prev 2000; 9(4):241-56.
  40. DH Committee on Carcinogenicity of Chemicals in Food, C.P.a.t.E.C. Chlorinated drinking water and cancer. 1999 Accessed.
  41. Villanueva CM, Cantor KP, King WD, et al. Total and specific fluid consumption as determinants of bladder cancer risk. Int J Cancer 2006; 118(8):2040-7.
  42. Villanueva CM, Fernández F, Malats N, et al. Meta-analysis of studies on individual consumption of chlorinated drinking water and bladder cancer. J Epidemiol Community Health 2003; 57(3): p. 166-73.
  43. Villanueva CM, Cantor KP, Cordier S, et al. Disinfection byproducts and bladder cancer: a pooled analysis. Epidemiology 2004; 15(3):357-67.
  44. Scientific Committee on Cosmetic Products and Non-Food Products Intended for Consumers.
  45. Gago-Dominguez M, Castelao JE, Yuan JM, et al. Use of permanent hair dyes and bladder-cancer risk. Int J Cancer 2001; 91(4):575-9.
  46. Gago-Dominguez M, Bell DA, Watson MA, et al. Permanent hair dyes and bladder cancer: risk modification by cytochrome P4501A2 and N-acetyltransferases 1 and 2. Carcinogenesis 2003; 24(3): 483-9
  47. Takkouche, B., Etminan, M., Montes-Martinez, A., Personal use of hair dyes and risk of cancer; a meta-analysis. JAMA 2005; 293(20): 2516-25.
  48. Huncharek M and Kupelnick B. Personal use of hair dyes and risk of cancer; results of a meta-analysis. Public Health Rep 2005; 120(1):31-8.
  49. Van Hemelrijck MJ, Michaud DS, Connolly GN, et al., Secondhand smoking, 4-aminobiphenyl, and bladder cancer: two meta-analyses. Cancer Epidemiol Biomarkers Prev 2009; 18(4):1312-20.
  50. Chaturvedi AK, Engels EA, Gilbert ES, et al. Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term ris.k JNCI 2007; 99(21):1934-43.
  51. Prizment AE, Anderson KE, Harlow BL, Folsom AR. Reproductive risk factors for incident bladder cancer: Iowa Women's Health Study. IJC 2007; 120(5):1093-8.
  52. McGrath M, Michaud DS, De Vivo I. Hormonal and reproductive factors and the risk of bladder cancer in women. Am J Epidemiol 2007; 163(3):236-44.
  53. Randi G, Pelucchi C, Negri E, et al. Family history of urogenital cancers in patients with bladder, renal cell and prostate cancers. IJC 2007; 121(12):2748-52.
  54. Aben KK, Witjes JA, Schoenberg MP, et al. Familial aggregation of urothelial cell carcinoma. IJC 2002; 98(2):274-8.
  55. Plna K and Hemminki K. Familial bladder cancer in the national Swedish family cancer database. J Urol 2001; 166(6):2129-33.
  56. Michaud DS, Pietinen P, Taylor PR, et al. Intakes of fruits and vegetables, carotenoids and vitamins A,C,E in relation to the risk of bladder cancer in the ATBC study. Br J Cancer 2002; 87(9):960-5.
  57. Holick CN, De Vivo I, Feskanich D, et al. Intake of fruits and vegetables, carotenoids, folate, and vitamins A,C,E and risk of bladder cancer among women (United States). Cancer Causes Control 2005; 16(10):1135-45.
  58. Tang L, Zirpoli GR, Guru K, et al. Consumption of raw cruciferous vegetables is inversely associated with bladder cancer risk. Cancer Epidemiol Biomarkers Prev 2008; 17(4):938-44.
  59. Michaud DS, Kogevinas M, Cantor KP, et al. Total fluid and water consumption and the joint effect of exposure to disinfection by-products on risk of bladder cancer. Environ Health Perspect 2007; 115(11):1569-72.
  60. Nordenvall C, Chang ET, Adami HO, et al. Cancer risk among patients with condylomata acuminata. Int J Cancer 2006; 119(4):888-893.
  61. Gutierrez J, Jimenez A, de Dios Luna J, et al. Meta-analysis of studies analyzing the relationship between bladder cancer and infection by human papillomavirus. J Urol. 2006; 176(6 Pt 1):2474-81.
  62. Jiang X, Castelao JE, Groshen S, et al. Water intake and bladder cancer risk in Los Angeles County. Int J Cancer 2008; 123(7):1649-56.
  63. Silverman DT, Alguacil J, Rothman N, et al. Does increased urination frequency protect against bladder cancer? Int J Cancer 2008; 123(7):1644-8.
  64. Parkin DM. Cancers attributable to occupational exposures in the UK in 2010. Br J Cancer 2011; 105(S2):S70-S72; doi: 10.1038/bjc.2011.487.
  65. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer 2006; 118: 3030-3044.
  66. Guha N, Steenland NK, Merletti F, et al. Bladder cancer risk in painters: a meta-analysis. Occup Environ Med 2010; 67(8):568-73.
  67. Parkin DM and Darby SC. Cancers attributable to ionising radiation exposure in the UK in 2010. Br J Cancer 2011; 105(S2):S57-S65; doi: 10.1038/bjc.2011.485.
  68. Rushton L, Bagga S, Bevan R, et al. Occupation and cancer in Britain. Br J Cancer 2010; 102:1428-1437.
  69. Baan R, Grosse Y, Straif K, et al. A review of human carcinogens - part F: chemical agents and related occupations. Lancet Oncol 2009; 10:1143-4.
  70. Brennan P, Bogillot O, Cordier S, et al. Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer 2000; 86(2):289-94.
  71. Brennan P, Bogillot O, Greiser E, et al. The contribution of cigarette smoking to bladder cancer in women (pooled European data). Cancer Causes Control 2001; 12(5):411-7.
  72. International Agency for Research on Cancer (IARC). IARC: DIESEL ENGINE EXHAUST CARCINOGENIC. Press release No 213, 12 June 2012. Available from
  73. Zhu Z, Shen Z, Lu Y, et al. Increased risk of bladder cancer with pioglitazone therapy in patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2012; 98(1):159-63.
  74. Azoulay L, Yin H, Filion KB, et al. The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study. BMJ 2012; 30:344.
  75. Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA 2011;306(7):737-45.
  76. Fang H, Yao B, Yan Y, et al. Diabetes mellitus increases the risk of bladder cancer: an updated meta-analysis of observational studies. Diabetes Technol Ther 2013;15(11):914-22.
  77. Zhu Z, Wang X, Shen Z, Lu Y, Zhong S, Xu C. Risk of bladder cancer in patients with diabetes mellitus: an updated meta-analysis of 36 observational studies. BMC Cancer 2013;13:310.
  78. Xu X, Wu J, Mao Y, et al. Diabetes mellitus and risk of bladder cancer: a meta-analysis of cohort studies. PLoS One 2013;8(3):e58079. doi: 10.1371/journal.pone.0058079.
  79. Zhu Z, Zhang X, Shen Z, et al. Diabetes mellitus and risk of bladder cancer: a meta-analysis of cohort studies. PLoS One 2013;8(2):e56662. doi: 10.1371/journal.pone.0056662.
  80. Ferwana M, Firwana B, Hasan R, et al. Pioglitazone and risk of bladder cancer: a meta-analysis of controlled studies. Diabet Med 2013;30(9):1026-32.
  81. Bosetti C, Rosato V, Buniato D, et al. Cancer risk for patients using thiazolidinediones for type 2 diabetes: a meta-analysis. Oncologist 2013;18(2):148-56.
  82. Colmers IN, Bowker SL, Majumdar SR, Johnson JA. Use of thiazolidinediones and the risk of bladder cancer among people with type 2 diabetes: a meta-analysis. CMAJ 2012;184(12):E675-83.
  83. Dietrich K, Demidenko E, Schned A, et al. Parity, early menopause and the incidence of bladder cancer in women: a case-control study and meta-analysis. Eur J Cancer. 2011 Mar;47(4):592-9.
  84. Davis-Dao CA, Henderson KD, Sullivan-Halley J, et al. Lower risk in parous women suggests that hormonal factors are important in bladder cancer etiology. Cancer Epidemiol Biomarkers Prev. 2011 Jun;20(6):1156-70.
  85. Daugherty SE, Lacey JV Jr, Pfeiffer RM, et al. Reproductive factors and menopausal hormone therapy and bladder cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer. 2013 Jul 15;133(2):462-72.
  86. Starup-Linde J, Karlstad O, Eriksen SA, et al. CARING (CAncer Risk and INsulin analoGues): The Association of Diabetes Mellitus and Cancer Risk with Focus on Possible Determinants- a Systematic Review and a Meta-Analysis. Curr Drug Saf. 2013 Nov 7.
  87. Turner RM, Kwok CS, Chen-Turner C, et al. Thiazolidinediones and associated risk of Bladder Cancer: a Systematic Review and Meta-analysis. Br J Clin Pharmacol. 2013 Dec 10.
  88. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: Accessed October 2013.
  89. Baan R, Straif K, Grosse Y, et al. Carcinogenicity of some aromatic amines, organic dyes, and related exposures. Lancet Oncol. 2008 Apr;9(4):322-3.
  90. Harling M, Schablon A, Schedlbauer G, et al. Bladder cancer among hairdressers: a meta-analysis. Occup Environ Med. 2010 May;67(5):351-8.
  91. Takkouche B, Regueira-Méndez C, Montes-Martínez A. Risk of cancer among hairdressers and related workers: a meta-analysis. Int J Epidemiol. 2009 Dec;38(6):1512-31.
  92. Turati F, Pelucchi C, Galeone C, et al. Personal hair dye use and bladder cancer: a meta-analysis. Ann Epidemiol. 2014 Feb;24(2):151-9.
  93. He H, Shui B. Folate intake and risk of bladder cancer: a meta-analysis of epidemiological studies. Int J Food Sci Nutr. 2013 Dec 16.
  94. Ni J, Qiu LJ, Hu LF, et al. Lung, liver, prostate, bladder malignancies risk in systemic lupus erythematosus: evidence from a meta-analysis. Lupus. 2014 Mar;23(3):284-92.
  95. Tang X, Yang L, He Z, et al. Insulin glargine and cancer risk in patients with diabetes: a meta-analysis. PLoS One. 2012;7(12):e51814.
  96. Karlstad O, Starup-Linde J, Vestergaard P, et al. Use of insulin and insulin analogs and risk of cancer - systematic review and meta-analysis of observational studies. Curr Drug Saf. 2013 Nov;8(5):333-48.
  97. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from Accessed February 2014.
  98. International Agency for Research on Cancer. Monographs on the evaluation of carcinogenic risks to humans, vol 100C. Arsenic and arsenic compounds Available from Accessed April 2014.
  99. Tsuji JS, Alexander DD, Perez V, et al. Arsenic exposure and bladder cancer: Quantitative assessment of studies in human populations to detect risks at low doses. Toxicology. 2014 Mar 20;317:17-30.
  100. Yan L, Chen P, Chen EZ, et al. Risk of bladder cancer in renal transplant recipients: a meta-analysis. Br J Cancer. 2014 Apr 1;110(7):1871-7.
  101. Ros MM, Bas Bueno-de-Mesquita HB, Büchner FL, et al. Fluid intake and the risk of urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition (EPIC). Int J Cancer. 2011 Jun 1;128(11):2695-708.
  102. Zhou J, Smith S, Giovannucci E, et al. Reexamination of total fluid intake and bladder cancer in the Health Professionals Follow-up Study Cohort. Am J Epidemiol. 2012 Apr 1;175(7):696-705.
  103. Zhou J, Kelsey KT, Giovannucci E, et al. Fluid intake and risk of bladder cancer in the Nurses' Health Studies. Int J Cancer. 2014 Feb 5.
  104. Noto H, Goto A, Tsujimoto T, et al. Cancer risk in diabetic patients treated with metformin: a systematic review and meta-analysis. PLoS One. 2012;7(3):e33411.
  105. Jégu J, Colonna M, Daubisse-Marliac L, et al. The effect of patient characteristics on second primary cancer risk in France. BMC Cancer. 2014 Feb 15;14:94.
  106. Youlden DR, Baade PD. The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study. BMC Cancer. 2011 Feb 23;11:83.
  107. Keimling M, Behrens G, Schmid D, Jochem C, Leitzmann MF. The association between physical activity and bladder cancer: systematic review and meta-analysis. Br J Cancer. 2014;110(7):1862-70.
  108. Lewis JD, Habel L, Quesenberry C, et al. Proteinuria testing among patients with diabetes mellitus is associated with bladder cancer diagnosis: potential for unmeasured confounding in studies of pioglitazone and bladder cancer. Pharmacoepidemiol Drug Saf 2014;23(6):636-45.
  109. Reulen RC, Frobisher C, Winter DL, et al. Long-term risks of subsequent primary neoplasms among survivors of childhood cancer. JAMA 2011;305(22):2311-9.
Updated: 21 May 2014