Bladder cancer risk factors: smoking, chemicals at work and more

What bladder cancer is

The bladder is a hollow organ in the lower abdomen that stores urine. Bladder cancer occurs in the lining of the bladder. It is the sixth most common type of cancer in the United States (MedlinePlus).

Many risk factors do not directly cause bladder cancer. Instead, they raise the chance of DNA damage in bladder cells that may lead to cancer (NCI risk factors).

Risk factors you cannot change

• Age. Bladder cancer can be diagnosed at any age, but the risk goes up as a person gets older (NCI risk factors).
• Sex and race. In the United States, bladder cancer occurs more often in men than in women, and more often in White people than in Black people (NCI risk factors).
• Family history. Having a family history of bladder cancer raises the risk (NCI risk factors) (MedlinePlus).
• Gene changes. Certain gene changes are linked to bladder cancer, such as HRAS, RB1, PTEN/MMAC1, NAT2 and GSTM1 (NCI risk factors).

Risk factors you may be able to change

• Tobacco, especially cigarettes. Using tobacco is a major risk factor. Tobacco contains cancer-causing chemicals that are absorbed into the blood, filtered by the kidneys and collected in the urine. This exposes the bladder lining to high levels of these chemicals, which can damage the DNA in its cells (NCI risk factors).
• Chemicals at work. Being exposed to paints, dyes, metals or petroleum products in the workplace (NCI risk factors).
• Drinking water. Drinking water from a well with high levels of arsenic, and drinking water that has been treated with chlorine, are both on NCI's list (NCI risk factors).
• Some past cancer treatments. Radiation therapy to the pelvis, or certain anticancer drugs such as cyclophosphamide or ifosfamide (NCI risk factors).
• Aristolochia fangchi. Taking this Chinese herb (NCI risk factors).
• Long-term urinary catheters. Using urinary catheters for a long time (NCI risk factors).
• A parasite infection. A bladder infection with the parasite Schistosoma haematobium. It is common in Africa and the Middle East but rare in the United States (NCI risk factors).

Having one or more of these does not mean you will get bladder cancer. Many people with risk factors never develop it, and some people with no known risk factor do (NCI risk factors).

If you smoke, the quit smoking help check covers the help available to quit.

Signs to check with a doctor

The most common sign is blood in the urine (hematuria). It is often slightly rusty to bright red. You may see it once and then not again for a while, and sometimes the amount is so small that only a urine test finds it (NCI symptoms). Other common symptoms (NCI symptoms):

• urinating often
• pain or burning when you urinate
• feeling you need to urinate even when your bladder is not full
• urinating often during the night

When the cancer has grown large or spread, symptoms may include being unable to urinate, lower back pain on one side, pain in the abdomen, bone pain, weight loss and loss of appetite you did not intend, swollen feet and tiredness (NCI symptoms).

Check with your doctor if you have any of these. Urinary tract infections, kidney or bladder stones and other kidney problems can cause them too. The first step is usually a urine sample (NCI symptoms).

Blood in the urine can also be a sign of kidney cancer; see kidney cancer risk factors.

Screening: what NCI says

There is no standard screening test for bladder cancer in people at average risk. Some tests, such as a urine test for blood, urine cytology, urine tumor marker tests and cystoscopy, may be used for people who had bladder cancer before or who are at higher risk (NCI screening).

False-positive results are common with tests for blood in the urine, because blood in the urine is usually caused by something other than cancer. They can lead to worry and more tests, such as cystoscopy. A false-negative result may lead someone to delay care even if they have symptoms (NCI screening).

For what the US Preventive Services Task Force says about screening adults without symptoms, see the bladder cancer screening check. All cancer checks are on the cancer screening hub.

Common questions

Is smoking the main cause of bladder cancer?

NCI calls tobacco use, especially smoking cigarettes, a major risk factor, because the chemicals in tobacco collect in the urine and reach the bladder lining (NCI risk factors). Workplace chemicals, arsenic in well water, past pelvic radiation and the other factors above also raise the risk (NCI risk factors).

Which chemicals are linked to bladder cancer?

NCI lists paints, dyes, metals and petroleum products at work, arsenic in well water and chlorine-treated drinking water (NCI risk factors).

Does alcohol raise bladder cancer risk?

Alcohol is not on NCI's list of bladder cancer risk factors (NCI risk factors). Alcohol does raise the risk of several other cancers; the alcohol and cancer risk guide lists them.