Bladder Cancer Risk Factors: What Causes Bladder Cancer?

What causes bladder cancer?

While not all of the risk factors for bladder cancer are understood, doctors know that certain behaviors and environmental exposures can increase someone’s risk for getting bladder cancer.  Some are impossible to avoid, while you have control over others. Smoking is often a leading cause of bladder cancer, as it introduces toxins into the bladder, while exposure to certain chemicals at work is another potential cause. Heredity, age, gender and race may also play a role in your risk for bladder cancer, and it is important to rule out what is causing your symptoms to determine if bladder cancer is the cause.

Smoking

If you are a current smoker with bladder cancer, there are many resources to help you quit. Read our tips on how to quit smoking, understand the connection between Smoking Cessation and Cancer Survivorship, published in the Journal of the American Medical Association. There are many resources to help you quit smoking. Learn about the risks of smoking and bladder cancer. 

Chemical exposure

Exposure to certain chemicals, usually in the workplace, is linked to an increased risk of bladder cancer in people. The chemicals used in making dye, and chemicals labeled aromatic amines may produce a higher risk for bladder cancer if exposed in your job or hobbies. Some common areas where these types of chemicals are found include rubber making, leather, printing materials, textiles, and certain paint products. Other chemicals in your home or work environment can also increase your risk of developing bladder cancer.

PFAS

PFAS are widely used, long-lasting chemicals. Scientific studies have shown that exposure to PFAS found in the blood of people and animals may increase health risks, including bladder cancer. PFAS (per- and polyfluoroalkyl substances) are a group of man-made chemicals widely used in industrial and consumer products for their resistance to water, oil, heat, and stains. Commonly referred to as “forever chemicals,” PFAS are extremely durable, breaking down very slowly in the environment and in human bodies.

If you are concerned about your risk of bladder cancer risk factors based on chemical exposure, it’s important to learn more about what chemicals you have been exposed to on a consistent basis at work.

Race

Although the reason is not clear, Caucasians are twice as likely to develop bladder than African Americans or Hispanics. Asians have the lowest rate of bladder cancer. Black, Asian, Hispanic, and Native Americans are often diagnosed at a later stage with bladder cancer. While you have no control over your race, understand the risks associated with different races.

Age

As you get older, the risk of bladder cancer increases. The average age of a person diagnosed with bladder cancer is 73. While bladder cancer is more common in older people over the age of 55, adults of any age may develop the disease. 

Gender

Though men get bladder cancer more often than women, recent statistics show an increase in the number of women being diagnosed with the disease. Unfortunately, because the symptoms of bladder cancer are similar to those of other gynecologic and urinary diseases affecting women, women may be diagnosed when their disease is at a more advanced stage. Learn more about bladder cancer in women.

For emerging evidence that suggests that sex (gender) influences the ability of bladder cancers to establish and/or proliferate, watch the Biologic Sex Differences in Bladder Cancer recording.

Chronic bladder inflammation

Urinary infections, kidney stones, and bladder stones are not a cause of bladder cancer, but they are linked to the disease. They may be symptoms that something more serious could be going on and should be evaluated by a physician.

Read Megan’s story, whose recurring UTIs led her to visiting her physician and eventually receiving a bladder cancer diagnosis.

Personal history of bladder cancer

If you have had bladder cancer in the past, you are at risk for developing another cancerous tumor in your urinary system. Once you have been diagnosed with bladder cancer and treated, you will be monitored over the years to make sure new tumors don’t develop.

Birth defects of the bladder 

Very rarely, a connection between the navel or belly button and the bladder called the urachus, doesn’t disappear as it should before birth. That connection can become a rare form of bladder cancer known as urachal cancer.

Arsenic

Arsenic can occur naturally in groundwater, but it also has been used in some pesticides. The International Agency for Research on Cancer (IARC) classifies arsenic in drinking water as a known cause of bladder cancer. This classification is largely based on studies of people living in Southeast Asia and South America where levels of arsenic in drinking water were especially high—many times higher than those typically seen in the U.S.

New evidence shows that even low-to-moderate levels of arsenic exposure may increase bladder cancer risk. One study of private well owners in northern New England, where bladder cancer rates are 20 percent higher than the U.S. overall, found that those who drank more from private wells with arsenic-contaminated water had a greater risk. The trend was especially pronounced among people who used shallow drinking water wells, as shallow wells tend to be more vulnerable to human activity. Among those who got their drinking water from wells dug before 1960—when arsenical pesticides were used—risk of bladder cancer was double in those who drank more water compared to those who drank less.

Nitrate

Nitrate is a common drinking water contaminant that originates primarily from agricultural fertilizer, but also from animal manure, leaching from septic systems, and sewage. In recent years, nitrate levels in drinking water in agricultural areas have increased with the higher use of fertilizers and other farming activities. Small water supplies in poor rural areas are especially vulnerable because of their proximity to farms and their limited financial and technical resources.

Studies show nitrate causes bladder tumors in animals, yet few studies have looked at the link between nitrate in drinking water and bladder cancer in humans. Results from the Iowa Women’s Health Study did find that long-term exposure to high nitrate levels in drinking water was associated with an increased risk of bladder cancer among postmenopausal women. However, more research is needed to determine if nitrate in drinking water is a risk factor.

Chemotherapy and radiation

Some drugs (in particular Cytoxan/cyclophosphamide) or radiation used to treat other cancers can increase the risk of bladder cancer. While you want to make sure you get the treatment you need for existing cancer, understand that this is a risk factor for developing bladder cancer in the future.

While you can’t eliminate your risk of bladder cancer, you can make some changes to your life that will help you stay healthier. Increase your intake of healthy fruits and vegetables. Reduce or eliminate your exposure to harmful chemicals whenever possible. If you are a smoker, it is time to quit by getting the right support in place to quit smoking successfully.

Learn about nutrition’s impact on bladder cancer prevention, treatment, and survivorship.

How can I reduce my risk for bladder cancer?

EPA’s drinking water standard for nitrate is 10 parts per million (ppm). It was established to protect infants from blue baby syndrome. However, because of potential long-term health effects, including cancer, exposure to levels below the federal standard may still be a concern. What’s more, nitrate is often a marker for other contaminants in well water. If private well testing reveals nitrate levels greater than 1 ppm, this suggests other contaminants may have seeped into the well.

Have your water tested. For private well owners, EPA recommends testing your water annually for nitrates and bacteria. Consider testing for arsenic, volatile organic compounds (chemicals found in gasoline and solvents), and pesticides as well since these are common contaminants in private wells.

Install a filter. Disinfection byproducts, arsenic, and other contaminants can be removed with various filtration devices—either a reverse osmosis, ion exchange, or distillation system. Counter-top filtration systems (e.g., Brita) do not filter arsenic or disinfection byproducts. Contact a professional to determine which device is best for you given your drinking water quality. Once installed, it is important to test your water annually to ensure the system is working effectively.

Contact your water utility. Request information about levels of disinfection byproducts in your public drinking water. Ask whether they are utilizing best available technologies and practices to minimize the formation of disinfection byproducts.

Advocate for safer rules. Call on EPA to set maximum contaminant levels.

Does alcohol cause bladder cancer?

The link between alcohol consumption and bladder cancer is not well-established. Current research does not provide strong evidence that alcohol directly causes bladder cancer. However, some studies suggest a potential association, particularly with heavy alcohol consumption, but the findings are inconsistent.

More information about bladder cancer risk factors