Continuing to Smoke After Bladder Cancer Diagnosis Increases Recurrence Risk

Smoking cigarettes could lead to a four-fold increased risk of recurrence in patients with a previous diagnosis of non-muscle invasive bladder cancer.

Smoking may significantly increase the risk of non-muscle invasive bladder cancer recurrence, which highlights the importance of quitting the habit to lower one’s risk.

In a recent study performed at the Notre Dame des Secours University Hospital in Lebanon, patients with high levels of urinary cotinine, a specific biomarker of tobacco smoke exposure, may have a four times increased risk of non-muscle invasive bladder cancer recurrence.

“It’s interesting that (the researchers) could sort out who had the highest risk based upon this urine level, but it actually gets away from what the real message should be, which is if you're smoking and you continue to smoke, you will have a much higher chance that your cancer will come back in your bladder, and when it comes back, it may be more aggressive and it may spread,” Dr. Nancy Dawson, professor of medicine and oncology and director of the genitourinary medical oncology program at Lombardi Comprehensive Cancer Center at Medstar Georgetown University Hospital in Washington, D.C., told CURE® in response to the study results. “What you really need to do is try to quit smoking.”

According to the Centers for Disease Control and Prevention, cigarette smoking accounts for 1 in 5 deaths every year and is the leading cause of preventable disease, disability and death. In addition, the American Cancer Society estimates that there will be over 83,000 new cases of bladder cancer in 2021. Of these cases, about 1 in 3 bladder cancers will be invasive.

“We know that smoking is a is a major risk factor for getting bladder cancer,” Dawson explains.

For newly diagnosed non-muscle invasive bladder cancer, the standard of care is a transurethral resection of the bladder tumor, also known as TURBT. This procedure is performed by inserting an instrument through the urethra. A resectoscope (a small camera) with a wire loop at the end is used to remove any abnormal tissues or tumors, which are then sent to the lab for testing. Overall, the procedure does not require any surgical incisions.

For those who continue to smoke after procedure, the chances of recurrence are high. “Having bladder cancer is not good, but having bladder cancer and continuing to smoke is worse,” Dawson emphasized. In the recently presented study, conclusive data demonstrated that recurrence was observed in 51.85% of patients, 75% of whom were heavy smokers (cotinine levels higher than 550 ng/ml) and 18.18% of whom were moderate smokers (cotinine levels below 550 ng/ml). On average, patients had been smoking for 30.3 years.

In the case of recurrence, Dawson said that doctors will likely perform the TURBT again, “but each time they go back, there's that chance that this cancer that they scooped out may now be invading into the muscle. Each time that (doctors) go back in there, they're thinning out the wall of the bladder, so you can’t do that indefinitely.”

If the cancer recurs more than three times, there’s also an increased chance of having bladder removal surgery and an ostomy, which changes how urine or stool exists the body.

“That's life altering, and although people adjust to having an ostomy (bag), … that’s not something people want to have,” Dawson said. “I think it may help in decision-making about smoking or not smoking … if you realize that you're actually putting yourself in a scenario where you may have to have something (like cancer) that you probably don't want.”

Dawson added that smoking cessation after receiving a diagnosis of non-muscle invasive bladder cancer can be beneficial.

“Ex-smokers are less likely to have a recurrence, so you can actually improve. It's not like, ‘I've been smoking all my life so what good (is it) to stop now?’” she explained.

For those moderate to heavy smokers looking to quit, Dawson recommends finding a smoking cessation program either inside or outside of the cancer center, and of course communicating with your health care team. “I feel it's our responsibility as physicians to do what we can to help patients who want to help themselves don't make it so hard,” she concludes.

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