National Bladder Cancer Study
In 1978, the National Bladder Cancer Study (NBCS) inaugurated use of the entire SEER network to mount a large and rapid study to address a critical issue in cancer epidemiology. Prompted by the U.S. Food and Drug Administration's need to determine whether consumption of saccharin increased the risk of developing bladder cancer, investigators at the NCI and in ten SEER centers conducted the largest and most detailed investigation of bladder cancer to date. Interviews from nearly 3,000 cases and 6,000 controls provided an unprecedented opportunity to examine occupational, environmental, medical, and lifestyle influences on risk and resulted in dozens of reports in peer-reviewed journals. The study clearly demonstrated the power of SEER for epidemiology and led to wide use of the resource for population-based cancer research.
The study uncovered excess bladder cancer risk in truck drivers, workers exposed to motor exhaust, and workers within the chemical, rubber, and plastics industries. In addition to the known link to cigarette smoking, a link to the use of pipes or cigars emerged from the study, along with a detailed understanding of the beneficial effect of stopping smoking. Exposure to chlorination byproducts in drinking water supplies, a common environmental exposure, was associated with increased risk. People who had suffered three or more urinary tract infections also showed increased risk, as did those with bladder cancer in the family.
Several widespread exposures that had been suspected of increasing bladder cancer risk, including the use of saccharin and other artificial sweeteners, the consumption of coffee and tea, and the use of hair coloring products, were found to be unrelated to risk in this large, detailed study. Because the study included large numbers of women and African-Americans, it afforded unique opportunities to compare risk patterns in those groups to the white male majority. In addition, because the SEER network reflects the population at large, the male excess risk and the white excess risk could be separated according to the factors responsible.
Hoover RN, Strasser PH. Artificial sweeteners and human bladder cancer. Preliminary results. Lancet 1980;1(8173):837-840.
Hartge P, Hoover RN, West DW, Lyon JL. Coffee drinking and risk of bladder cancer. J Natl Cancer Inst 1983;70:1021- 1026.
Silverman DT, Hoover RN, Mason TJ, Swanson GM. Motor exhaust-related occupations and bladder cancer. Cancer Res 1986;46:2113-2116.
Cantor KP, Hoover R, Hartge P, Mason TJ, Silverman DT, Altman R, Austin DF, Child MA, Key CR, Marrett LD, Myers MH, Narayana AS, Levin LI, Sullivan JW, Swanson GM, Thomas DB, West DW. Bladder cancer, drinking water source, and tap water consumption: a case-control study. J Natl Cancer Inst 1987;79:1269-1279.
Schairer C, Hartge P, Hoover RN, Silverman DT. Racial differences in bladder cancer risk: a case-control study. Am J Epidemiol 1988;128:1027-1037.