BCAN Think Tank session 1: Overview of risks for and causes of bladder cancer

This article reviews the proceedings of the cause and risk session of the recently held BCAN Bladder Think Tank in 2009. Understanding associations between specific genetic changes and development of particular forms of bladder cancer, whether low-grade or more invasive forms, may justify screening programs for earlier detection. A fundamental epidemiological issue is causation. Associations are supported by high rates in industrialized regions and parallel associations with cigarette smoking. The evolution to molecular and integrative epidemiology incorporates molecular and cytogenetic markers in host and tumor tissue with classic epidemiology to develop risk assessment models to identify high-risk populations. Animal models can teach us something about human bladder cancer and address the issue of the differentiation between papillary low-grade and invasive high-grade tumors. After the diagnosis of a bladder tumor, pathological risk stratification becomes important but there are weaknesses in the current grading systems. Molecular grading may provide a new, simple, and highly reproducible tool to determine bladder cancer prognosis. Based on our current knowledge, including gaps in that knowledge, education is the immediate top-priority action item. The promotion of smoking cessation is also a high priority action. The symptoms of bladder cancer, particularly hematuria, must be emphasized to both the medical and lay. Given the costs associated with the treatment and surveillance of bladder cancer, a comprehensive program supported by governmental funding sources to identify the risks associated with bladder cancer development would seem prudent.