Bladder cancer mortality in England and Wales in relation to cigarette smoking and saccharin consumption

Lifestyle issues and genitourinary tumours

A variety of lifestyle factors, including physical activity, artificial sweeteners, alcohol consumption and smoking, have been reported to contribute to the risk of developing urological malignancies. A great number of epidemiological studies suggest that sports and physical activity may have a preventive influence on genitourinary tumours, especially on the incidence of prostate cancer. Smoking appears to be the most relevant lifestyle factor significantly increasing both incidence and mortality from bladder cancer. Furthermore, there is evidence implicating an association between tobacco use and kidney cancer. In contrast, prostate and testicular cancers are unlikely to be linked to tobacco use. As far as alcohol is concerned, most studies indicate that neither amount nor type of alcohol seems to be clearly associated with a risk of developing urological malignancies. However, some more recent cohort studies suggest a moderately increased risk for prostate and bladder cancer for specific types of alcohol. On the other hand, there is evidence that moderate alcohol consumption may even protect women from developing renal cancer. Since the introduction of artificial sweeteners, reports of potential cancer risks have circulated periodically through the mass media. The wide distribution of these agents and the fact that mostly combinations of the different compounds are added to a broad variety of food, drinks, drugs, and hygiene products complicates a systematic analysis of their potential impact on the development of urological malignancies. Nevertheless, so far not a single study has convincingly demonstrated a statistically significant risk of bladder cancer due to the consumption of artificial sweeteners. This survey demonstrates that the individual assessment of lifestyle factors not only may identify groups with an increased risk for urological malignancies but also clearly displays a potential for tumour prevention.

Using epidemiology to regulate food additives: saccharin case-control studies

The increasing use of nonnutritive sweeteners and the widely publicized 1969 ban on cyclamate led to additional investigations in rodents of the carcinogenic potential of saccharin. Preliminary results of a long-term feeding study indicated formation of bladder tumors in rodents, and collective experimental evidence has demonstrated that high doses of the synthetic sweetener saccharin can cause bladder cancer in rodents. Based on the results of that and other rodent studies indicating an increased risk of bladder cancer associated with saccharin, the Commissioner of the Food and Drug Administration announced the agency's intention to propose a ban on saccharin. This intention was made known in April 1977 under the Delaney Clause of the Food, Drug, and Cosmetic Act. The clause essentially states that no additive shall be deemed safe if it is found to induce cancer in man or animals, or if it is found, after tests appropriate for the evaluation of the safety of food additives, to induce cancer in man or animals. Also in 1977, a group of epidemiologists began to assess the available epidemiologic information to determine the potential human risk. This report describes the assessment of several human epidemiologic studies available then and the results of more recent epidemiologic studies.

Design and methods in a multi-center case-control interview study

We conducted a case-control study in ten areas of the United States in which a total of 2,982 bladder cancer patients and 5,782 population controls were interviewed. We employed a variety of existing and new techniques to reduce bias and to monitor the quality of data collected. We review here many of the design elements and field methods that can be generally applied in epidemiologic studies, particularly multi-center interview studies, and explain the reasons for our selection of the methods, instruments, and procedures used.

Cigarette smoking and bladder cancer: an epidemiological inquiry in West Yorkshire

Results are given of a case-control study on bladder cancer in West Yorkshire. The aim of the study was to assess what risks exist for cigarette smoking in the United Kingdom and also to investigate if a dose response effect was present. The study shows for the first time in the United Kingdom a positive but weak relationship between cigarette smoking and bladder cancer. Close examination of the data with regard to this effect shows that a complex set of relationships result when the quantity smoked and the period of smoking are taken into account. A dose response effect is weakly demonstrated when a medium quantity of cigarettes are smoked but it is not present at all in those who smoked most cigarettes for the longest periods. No risk appears to exist for those who have smoked only filter cigarettes. The results are contrasted with similar studies and the significance of the observations are discussed.

The redundant factor method and bladder cancer mortality

Of the three factors, age at death, epoch of death, and epoch of birth, one seems almost superfluous. It may nevertheless be worthwhile to include all three in a mortality analysis, allowing for the constraints that the redundancy imposes. This procedure is applied to data for England and Wales on bladder cancer mortality from 1951 to 1970.

The role of the pathologist in environmental medicine and public health

The present paper summarizes the role of the morbid anatomist and clinical pathologist in environmental carcinogenesis. It points out that in the past he has contributed considerably to the identification of rare tumors and their etiology. He has an important role to play in the future in providing more accurate data on which epidemiology studies can be developed. The view is also expressed that it is highly important that modern pathologists have an understanding of toxicologic and pharmacologic techniques and their potential application to biologic material in order that they may be in a position to correlate and develop multidisciplinary approaches to the identification of environmental hazards. Some of these approaches are illustrated and their potential developments outlined.

Cancer mortality and saccharin consumption in diabetics

The mortality experience of 5971 members of the British Diabetic Association (BDA) was followed-up for between five and eight years to mid-1973. Overall, 1207 deaths occurred compared with 778 expected from the mortality of the population of England and Wales in 1972. This excess of deaths was due almost entirely to diabetes mellitus and ischaemic heart disease. Deaths from cancer (128) were significantly fewer than expected (168), mainly because of a deficit in the number of deaths from cancers related to smoking (cancers of the buccal cavity and pharynx, oesophagus, respiratory system, and bladder). There was also a lower than expected mortality from chronic bronchitis and emphysema. Data on saccharin consumption by BDA members showed that more than half of them used saccharin tablets daily, with an overall daily intake of three to six tablets, depending on age and sex. Information on a small sample of survivors from the mortality study suggested that about 23% of them would have taken saccharin daily for 10 years or more and 10% for 25 years or more by the end of the follow-up. It was concluded that these relatively high levels of saccharin intake had not increased the risk of cancer in general among BDA members.

Bladder cancer mortality in diabetics in relation to saccharin consumption and smoking habits

The frequency with which diabetes mellitus was mentioned on the death certificates of 18,733 patients dying from bladder cancer has been compared with that of 19,709 patients dying from other cancers (excluding cancer of the lung and pancreas). The estimated relative risk of bladder cancer in diabetics was 0-98 with 95% confidence limits 0-70-1-38. There was no increase in risk of bladder cancer in patients with diabetes of long duration. Diabetics were shown by questionnaire to consume substantially more saccharin than non-diabetics, and the duration of regular saccharin use by diabetics was highly correlated with the duration of diabetes. There was therefore no evidence from this study that consumption of above average amounts of saccharin had led to bladder cancer in diabetics. The proporation of current smokers among diabetics was significantly less than among non-diabetics, and this may account for a low relative risk of lung cancer in the former (0-72).