Smoking Cessation and the Risk of Bladder Cancer among Postmenopausal Women

Yueyao Li, Hilary A. Tindle, Michael S. Hendryx, Pengcheng Xun, Ka He, Xiaoyun Liang and Juhua Luo

DOI: 10.1158/1940-6207.CAPR-18-0441 Published May 2019


Smoking is the strongest established risk factor for bladder cancer. Former smokers have a lower risk of bladder cancer compared with current smokers, but findings on the dose–response relationship between years after quitting and the risk of bladder cancer are inconsistent. A total of 143,279 postmenopausal women from the Women’s Health Initiative Study were included. Cox proportional hazards regression models were applied for estimating age- and multivariable-adjusted HRs and their 95% confidence intervals (CI). There were 870 bladder cancer cases identified over an average of 14.8 years of follow-up. After adjusting for pack-years of smoking, bladder cancer risk among former smokers declined by 25% within the first 10 years of cessation and continued to decrease as cessation time increased but remained higher than never smokers after 30 years of quitting (HR, 1.92; 95% CI, 1.43–2.58). Smokers who quit smoking had a lower risk of bladder cancer compared with current smokers (HR, 0.61; 95% CI, 0.40–0.94). We conclude that among postmenopausal women, there is a significant reduction in the risk of bladder cancer after quitting smoking. In addition to primary prevention, smoking cessation is critical to prevent the incidence of bladder cancer in older women.




Screening for Osteoporosis After a Fracture Is Important, Especially in Older Women With a Low BMI

: Presented at ECE

By Jenny PowersLYON, France — May 21, 2019 — A study presented here at the 21st European Congress of Endocrinology (ECE) underscored the importance of screening for osteoporosis after a fracture, especially in women aged older than 50 years with low body mass index (BMI).

Randi Tei, PhD, Aarhus University Hospital, Aarhus, Denmark, and colleagues analysed data from a cohort of Danish patients receiving treatment for fragility fractures at Aarhus University Hospital over a 12-month period. Of 1,164 identified patients, 794 completed the study and underwent dual x-ray absorptiometry (DXA).

The overall prevalence of osteoporosis in this cohort was 14.9%. Of the 118 patients with osteoporosis, 20 had previously been diagnosed with osteoporosis. The incidence rate increased to 20.3% in those aged ≥50 years. The incidence rates were 22.9% in women and 9.6% in men.

Age ≥50 years (odds ratio [OR] = 4.7), female sex (OR = 2.5), a BMI <20 (OR = 5.7), and early menopause (OR = 2.3) were all significantly associated with risk for osteoporosis.

At 3-years of follow-up, interviews were conducted in 93 of the 98 patients diagnosed with osteoporosis. Of these patients, 84 took calcium and vitamin D supplements. However, despite supplementation, 10 individuals had experienced a subsequent minor fracture. Another 75 patients were prescribed anti-osteoporosis treatment from their general practitioner as a result of their DXA result. Of these, 71 (95%) were treatment adherent after 3 years. A subsequent DXA test was done in 56 patients, which revealed that 49 (87.5%) had increased bone mineral density.

“Given that osteoporosis was demonstrated in 1 of 5 patients aged 50 years or older treated for a fracture at Aarhus University Hospital, [this study] stresses the need for implementation of a program aiming to secure appropriate investigation and treatment in patients presenting with a fragility fracture,” said Dr. Tei.

“Worldwide, a care gap has been recognised between presenting with a fragility fracture and prevention of the next fracture,” she added. “A Fracture Liaison Service is the most cost-effective method to close this gap, but its implementation is sparse in many countries.”

[Presentation title: OFELIA – Prevalence of Osteoporosis in Fragility Fracture Patients. Abstract GP22]



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