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Am Fam Physician. 2000;61(7):2219-2222

Transitional cell carcinoma of the bladder is the fifth most common human neoplasia, yet one of the more preventable diseases related to tobacco exposure. Superficial transitional cell carcinoma accounts for the majority of these cancers. The average three-year recurrence-free survival rate ranges from 35 to 70 percent. Because of the risk for recurrence, patients with this neoplasia are followed closely with repeating surveillance studies on a regular basis. Despite the fact that tobacco has been associated with this neoplasia, no studies have been formed to determine what effect smoking has on recurrence. Fleshner and associates studied recurrence rates in patients who continued to smoke, those who stopped smoking at the time of the diagnosis and those who quit before the diagnosis.

The study was a retrospective cohort design. Data were collected from all patients who were diagnosed with superficial transitional bladder cell carcinoma at a major cancer center from 1985 to 1995. Patients were included in the study if they had at least a 20 pack-year history of smoking and continued to smoke within 10 years before the diagnosis. The patients were divided into ex-smokers (those who quit at least one year before diagnosis), quitters (those who quit less than one year before and up to three months after the diagnosis) and continuing smokers. Outcomes studied included recurrence-free survival and survival free of adverse events.

There were no significant differences between the three groups with regard to demographics and basic disease parameters. Those who were ex-smokers and those who quit at the time of the diagnosis had better recurrence-free survival rates than those who continued to smoke. This trend was also noted when looking at adverse events.

The authors conclude that patients with superficial transitional cell carcinoma of the bladder who continue to smoke experience worse outcomes than those who quit smoking. Smoking cessation should be emphasized as a vital component of the treatment regimen in patients with this neoplasia.

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