The New England Bladder Cancer Study
Condition: Bladder Cancer
MeSH terms: Urinary Bladder Neoplasms
Study type: Observational

Summary: 
      Data from the new cancer atlas covering the period 1974 1994 indicates that deaths from
      bladder cancer among white men and women are elevated in the northeastern United States,
      particularly the northern parts of New England. The reason for these elevated rates of
      incidence of and deaths from bladder cancer is unknown. Only part of the excess risk can be
      explained by exposure to the textile and leather industries.

      The purpose of this study is to determine the factors that contribute to the high rates of
      incidence of and death from bladder cancer in northern New England. The main objectives are
      to:

        -  estimate the risk of developing bladder cancer associated with inorganic arsenic in
           drinking water, other water contaminants, tobacco use, occupational exposures,
           residential proximity to industrial sites, dietary factors, ethnicity, and use of
           wood-burning stoves.

        -  estimate the extent to which water containing inorganic arsenic explains the increased
           rates of bladder cancer.

        -  estimate the extent to which exposure to other risk factors explains the increased
           rates.

        -  evaluate risk of bladder cancer according to genetic factors.

        -  examine interactions of these factors with tobacco use, occupational exposure, and
           environmental exposure to arsenic and other compounds.

      All people ages 30 79 with confirmed cases of bladder cancer will be eligible for the study.
      Twelve hundred people with bladder cancer and twelve hundred individuals with no previous
      bladder cancer will be included.

      After potential participants are recruited and agreement is obtained over the telephone, they
      will complete a calendar and collect toenail clippings prior to the home interview. During
      the home visit, an investigator will administer a computer-assisted personal interview,
      collect drinking water samples and the clippings, and obtain a global positioning satellite
      reading. Other biological samples, such as saliva samples, urine, and blood, may be
      requested.

      Private wells at any previous homes of participants will also be sampled. The location of
      previous homes will be determined and the current homeowner will be asked to allow sampling
      of the well.

      The associations between bladder cancer and environmental exposures will be examined and the
      extent to which exposures to such risk factors explain the elevated mortality and incidence
      in northern New England will be estimated.

      ...
    

Detailed description: 
      Data from the new cancer atlas covering the period 1970-94 indicate that bladder cancer
      mortality rates among white men and women are elevated in the northeastern U.S., particularly
      in the northern parts of New England including Maine, New Hampshire, and Vermont. The reasons
      for these high mortality rates are unclear. The persistent elevations in mortality and
      incidence for bladder cancer among both men and women suggest the possible role of
      environmental etiologic factors. A leading suspect environmental exposure is inorganic
      arsenic in drinking water, which is elevated in private wells in parts of New England. The
      purpose of this study is to determine the risk factors that explain the high mortality and
      incidence rates for bladder cancer in men and women in northern New England. The study will
      be a population-based case-control study of carcinoma of the urinary bladder in three states:
      New Hampshire, Vermont, and Maine. All histologically-confirmed incident cases of carcinoma
      of the bladder occurring within a three-year period among residents of the study areas
      between the ages of 30 and 79 years will be eligible for the study. Controls will be selected
      randomly from the general population of each study area, frequency matched to the age-,
      race-, and gender-specific distributions of incidence cases of bladder cancer in each state.
      We expect to interview 1,200 cases and 1,200 controls. Several data collection activities
      will be incorporated in this study: a self-administered residential/occupational history
      calendar, a self-administered diet questionnaire, in-person interviews with subjects using a
      computer-assisted personal interview (CAPI), collection of drinking water to determine levels
      of arsenic and other contaminants in drinking water, a collection of buccal cells, toenails,
      spot urine, four-day urinary habits diary, overnight urine (from a sample of 240 cases and
      240 controls), and blood (from a sample of 180 cases and 180 controls). Tumor tissue samples
      will be obtained for cases. We will examine associations between bladder cancer and
      environmental exposures, and estimate the extent to which exposures to such risk factor
      explain the elevated mortality and incidence in northern New England.
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Case patients included all patients with histologically confirmed carcinoma of the urinary
        bladder (including carcinoma in situ) newly diagnosed between 2001 and 2004 among residents
        of Maine, New Hampshire, and Vermont, age 30 to 79 years. Patients were ascertained through
        hospital pathology departments and hospital and state cancer registries. Control subjects
        were selected randomly from state Department of Motor Vehicle (DMV) records (age 30-64
        years) and Centers for Medicare and Medicaid Services (CMS) beneficiary records (age 65-79
        years), frequency matched to case patients by state, sex, and five-year age group at
        diagnosis. We interviewed 1418 (594 DMV, 824 CMS) control subjects (64.8% of eligible DMV
        and 64.7% of eligible CMS control subjects).@@@
      
Keywords: Bladder Cancer; Exposure; Drinking Water