Bladder cancer - UK incidence statistics

In the UK bladder cancer is the fourth most common cancer in males, with 7,307 new cases diagnosed in 2006. 1-4 This compares to 2,957 female cases, giving a male:female ratio of 5:2. In females it is the eleventh most common cancer.

The numbers and rates for the UK and its constituent countries are shown in Table 1.1. 1-4

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Few cases occur under the age of 50, but thereafter the rates rise with age to reach a peak in the oldest age-groups when rates in elderly men are more than three times higher than in elderly women ( Figure 1.1). 1-4

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British data show only a small deprivation gradient, with the lowest bladder cancer rates recorded for the most affluent and the highest for the most deprived groups. 7,8 The latest analysis for data from England showed similar results with age-standardised bladder cancer incidence rates of 11.2 per 100,000 population for the most affluent compared with 13.7 for the most deprived. 14

An analysis of cancer incidence in the UK and Ireland highlighted considerable differences between cancer registries in the classification of bladder tumours which make the interpretation of any geographical patterns difficult. 6 These differences in registration practice will also limit international comparisons.

The 2002 estimated age-standardised bladder cancer incidence rates reported for UK men are well below the EU average (25.3 v 34.4 per 100,000 population respectively) and the rate for women in the UK is slightly higher than (7.9 v 7.0 per 100,000 population respectively) as Figure 1.2 shows. More recent age-standardised rates for the UK show a further drop - 19.8 for men and 5.9 for women (see Figure 1.5 below).

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Worldwide an estimated 356,600 new cases of bladder cancer occur each year and, in terms of overall cancer frequency, it is ranked as ninth. 5 World incidence rates for bladder cancer show comparatively low variation ( Figure 1.3) compared to other cancers. 9

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The highest bladder cancer incidence rates are generally found in industrially developed countries, particularly in North America and Western Europe, and in areas associated with endemic schistosomiasis in Africa and the Middle East. Egypt has the highest reported rates (37 per 100,000 population) in the world due to endemic schistosomiasis. Very low rates (< 5 per 100,000 population) are reported for India and China.

Marked racial differences have been reported for bladder cancer incidence with higher rates in white than non-white populations. For example, in the USA, rates for white men are double those for black men: in 2000-2003 the age-adjusted incidence rate per 100,000 population was 40.2 for white males compared to 19.8 in black Americans. Bladder risk for US black women is about two-thirds that of US white women. 10

These differences may be partly due to genes, as studies have shown that certain genetic polymorphisms linked to an increased risk of bladder cancer (for example, the NAT2 slow acetylator polymorphism) are much more prevalent in white than non-white populations 11 - see Molecular Biology and Genetics section for more details.

Time trends in bladder cancer incidence rates are difficult to interpret because of different and changing classification/coding practices affecting the definition of invasive carcinoma of the bladder.

In Great Britain, the age-standardised incidence rates per 100,000 population rose throughout the 1970s and 1980s to reach a peak of 32 in men and 9 in women in the early 1990s and since then have fallen by around a third. ( Figure 1.4). 12

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UK bladder cancer incidence trends are shown in Figure 1.5

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The age-specific bladder cancer incidence rates in Great Britain Figure 1.6 and Figure 1.7 show a consistent decrease since the early 1990s for all age-groups under age 85. 12 Some of this decrease is likely to be due coding changes but reductions in smoking and exposure to occupational carcinogens may also have played a role, especially as the mortality rates have also decreased. 13

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In developed countries around 90% of bladder cancers are transitional cell carcinomas while the remaining 10% are squamous cell carcinomas and adenocarcinomas. Benign transitional cell papillomas have sometimes and in some places been registered as invasive carcinomas. This variation in registration practice has to be taken into account when comparing incidence and survival rates over time and place. 6

Where the bladder cancer is associated with chronic bladder infection, most commonly with waterborne parasitic flatworms called schistosomes, the usual histology is squamous cell carcinoma. Schistosomiasis-associated bladder cancer has an earlier mean age at onset, typically in the fifth decade of life, and tends to present at a later stage than transitional cell carcinomas.

In countries where schistosomiasis (also called bilharzia ) is endemic, such as Egypt, bladder cancer is the most common cancer in men. 5 Prevention of infection in these countries is paramount. 7 Subsequent information in this section concerns bladder cancer in the UK and other developed countries unless otherwise specified.