Environmental factors affecting the risk of urothelial carcinoma



LIVING PATIENTS in geospatial hotspots of urothelial carcinoma (UC) prevalence are less likely to be white, to have a higher income, or to be tobacco users, and more likely to reside near sources of byproducts industrial and environmental pollutants (IBP / EP), according to researchers from Charlotte, NC, and Wynnewood, PA. The results of their study were presented in a session on “Optimizing personalized management of muscle-non-invasive bladder cancer” at the 2021 ASCO Symposium on Genitourinary Cancers.

“The risk factors for UC are well documented, with up to 65% of the incidence of UC attributable to tobacco use,” said study presenter Dr. Daniel C. Edwards ( Levine Cancer Institute at Atrium Health, Charlotte). “In addition, industrial and occupational exposure, such as coal mining, petroleum refining, tire manufacturers, painters, dye workers, etc., can be attributed up to 7% of the ‘incidence of UC. ” Cancer has been linked to environmental exposures, but research on the effects of non-occupational environmental risk factors has been limited, he explained.

Dr Edwards and his co-investigators searched a multi-institutional database to identify patients diagnosed with UC between 2008 and 2018 in five counties in southeastern Pennsylvania (population of approximately 4 million, annual UC incidence of approximately 1,000). Using geocoded addresses and ArcGIS software, they determined the Getis-Ord-Gi * statistic and performed hot spot analysis at the census block level to identify UC hot spots. Pearson’s chi-square and Student’s t-test were used to compare demographics, clinicopathologic features of the disease, and proximity to sources of IBP / PE. The correlation between patient and census block level factors and living in a UC hotspot was tested with fitted univariate analyzes and multivariable random interception logistic regression models at multiple levels.

A total of 5080 patients were identified, of which 148 correlated with one of the 3 identified UC hotspots. Univariate analyzes revealed that hot spot patients were less likely to be tobacco users (odds ratio [OR], 0.24; P= 0.004), be white (OR, 0.10; P

Multivariate analysis confirmed that patients residing in UC hotspots were less likely to use tobacco (OR, 0.11; P= 0.045) and less likely to be white (OR, 0.02; P= 0.004).

“In terms of exposure to polycyclic aromatic hydrocarbons, hot spot patients were 40 times more likely to live near a source of landfill. And hot spot patients were significantly more likely to reside near high density traffic hot spots, ”added Dr. Edwards.

“Ultimately, spatially related clusters of UC may be associated with local or regional environmental exposures. And patients residing in UC hotspots may be more likely to be less educated, low-income, female, or non-white. Socioeconomic disparities may be associated with an increased likelihood of living in risky environments, ”concluded Dr Edwards. “In terms of clinical correlation, research such as this ongoing study and future studies may help identify patients at risk of environmental exposure, allowing interventions to be undertaken, including patient education and care. primary care, which could improve screening, earlier diagnosis and treatment outcomes.


Edwards DC, Yankelevich GR, Dreher PC, et al. Socio-environmental conditions associated with geospatial clusters of urothelial carcinoma: a multi-institutional analysis. J Clin Oncol. 2021; 39 (6, suppl): 99. Abstract 392. doi: 10.1200 / JCO.2021.39.6_suppl.392

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