Introduction:

Public health policy changes have led to reductions in the incidence and mortality of smoking-related diseases in the US. Relative to other smoking-related cancers like lung, the incidence and survival of bladder cancer have remained virtually unchanged. Though these trends are multifactorial, prior studies have suggested that public awareness of the link between bladder cancer and smoking is lacking, and this may be contributory. We hypothesize that adults in the United States are less aware of the connection between smoking and bladder cancer compared with other, more widely recognized, health-related risks of smoking. We aimed to assess perceptions of smoking-related health risks among adult smokers in the US with a focus on bladder cancer awareness.

Methods:

This study is a cross-sectional analysis of Wave III of the Population Assessment of Tobacco and Health (PATH) study, an ongoing prospective representative-population based cohort study sponsored by the NIH and FDA. The PATH study collects baseline and follow-up information regarding tobacco-use patterns, including initiation and cessation behaviors, and tobacco and non-tobacco-related health outcomes. Our analytic cohort included active smokers at the time of Wave III survey who had smoked >100 cigarettes in their lifetime. Our primary outcomes were the perception of smoking-related risk for general harm, lung cancer, mouth cancer, bladder cancer, and heart disease. Additional analyses included assessment of these risk perceptions among adults with a urologic cancer diagnosis (prostate, kidney, bladder, or testicular) and those specifically with a bladder cancer diagnosis. Population weighted percentages with 95% confidence intervals were estimated using survey commands for a cross-sectional analysis of a single wave in STATA v.16 

Results:

Our analytic sample represented a population estimate of 43,816,304 adult smokers. Within this group, an estimated 457,005 had a urologic cancer history, and 130,025 had bladder cancer. Participant demographics and reported cancer diagnoses are summarized in Table 1. Among all adult smokers, the majority (93.5%) perceived smoking to be harmful to one’s health. 90.9% agreed that there is an association between smoking and lung cancer, 84% agreed there is an association between smoking and mouth cancer, and 88.1% agreed that there is an association between smoking and heart disease. However, only 50.8% of adult current smokers agreed that there exists an association between smoking and bladder cancer. This percentage increased slightly to 58.8% among adults with a GU cancer history and considerably increased to 87.0% among those with a reported history of bladder cancer (Figure 1). 

Conclusion:

Among active smokers, awareness of the link between smoking and bladder cancer lags far behind similar smoking-related disease processes like lung cancer, mouth cancer, and heart disease. Although the perception of smoking as a risk factor for bladder cancer was substantially improved among smokers who themselves had a bladder cancer diagnosis, the link between smoking and bladder cancer was still not universally recognized. Improved awareness of the causal association between smoking and bladder cancer, particularly among adults at high risk for continued complications from smoking, will likely contribute to improving population-level bladder cancer outcomes. Urologists must also play a critical role and leverage the benefits of smoking cessation after diagnosis through greater recognition and delivery of smoking cessation treatment in our clinics. 

Funding: N/A