High incidence of lung cancer after non-muscle-invasive transitional cell carcinoma of the bladder: implications for screening trials.

Purpose: Lung cancer screening trials depend on the selection of a sufficiently high-risk population. Because not all smokers develop cancer, we hypothesize that a history of tobacco-associated malignancy might more reliably predict for subsequent lung cancer. Because patients with early-stage bladder transitional cell carcinoma (TCC) often have a long survival, we considered whether they would constitute a suitable population for a screening study.

Patients And Methods: Patients with Ta/is/1 N0 M0 TCC of the bladder and no history of previous cancer treated surgically between 1983 and 2002 were studied using the Surveillance, Epidemiology, and End Results (SEER) database. The incidence and cancer-specific mortality of second nonurothelial solid organ cancers was determined. The standardized incidence ratio (SIR) and 15-year actuarial incidences were determined.

Results: From 1983 to 2002, 8300 patients meeting the inclusion criteria were entered into the SEER-9 Registry. Among them, the SIR for a second solid organ malignancy was 1.25 (95% CI, 1.18-1.32). The SIR was significantly increased for tumors of the lung (1.71), head and neck (1.32), and prostate (1.28). The 15-year incidence of and mortality from lung cancer were 8.8% and 8.6%, respectively. Among all nonurothelial second malignancies, lung cancers accounted for 32.5% of the incidence and 53.4% of cancer-specific deaths. Moreover, lung cancer accounted for 12.2% of overall deaths in these patients.

Conclusions: Patients with non-muscle-invasive bladder TCC suffer a high incidence of mortality from lung cancer and might constitute a suitable population for a lung screening trial. Other tobacco-related health events might add to smoking history in identifying high-risk populations.