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. 2025 Apr 24;83(1):113.
doi: 10.1186/s13690-025-01585-5.

Trends in tobacco smoking and bladder and lung-bronchial cancer rates among non-hispanic white Americans (2000-2016)

Diancarlos Pereira de Andrade  1   2 , Camila Moraes Marques  1   2 , Dayane Christina Rodrigues de Andrade  3 , Luana Lenzi  4 , Cláudia Sirlene Oliveira  1   2 , Bonald Cavalcante de Figueiredo  5   6
Affiliations

Trends in tobacco smoking and bladder and lung-bronchial cancer rates among non-hispanic white Americans (2000-2016)

Diancarlos Pereira de Andrade et al. Arch Public Health. .

Abstract

Background: Cancer incidence may be linked to cumulative exposure to environmental factors, including diet, lifestyle behaviors, licit drug use (such as tobacco), and endogenous processes. Tobacco smoking (TS) is strongly associated with bladder cancer (BC) and lung-bronchial cancer (LBC). This study aimed to analyze TS, BC, and LBC rates; their correlation with sex and age; and the risk of subsequent primary cancers among BC and LBC patients in non-Hispanic white Americans (NHWAs) from 13 U.S. states.

Methods: The percentage of smokers in 13 U.S. states from 2000 to 2016 was obtained from the Centers for Disease Control and Prevention (CDC) database. LBC and BC cases in NHWAs from 2000 to 2016 were analyzed as single primary cancers or as the first of two or more neoplasms using the United States Surveillance, Epidemiology, and End Results (SEER) database.

Results: The percentage of NHWA smokers decreased in all 13 U.S. states evaluated in this study from 2000 to 2016. Over 17 years, the incidence rates of BC were 36.37 and 11.66 cases per 100,000 among men and women, respectively, while those of LBC were 68.21 and 61.53 cases per 100,000, respectively. The highest incidence rates of BC and LBC occurred in individuals over 64 years of age: BC in New York (208.9 per 100,000 men) and Massachusetts (54.33 per 100,000 women), and LBC in Kentucky (503.1 per 100,000 men; 298.5 per 100,000 women). The incidence rates of BC and LBC were correlated in most states, especially in Massachusetts, California, New Jersey, and New York. Among the 657,117 patients with LBC, 4.3% had a second type of cancer, while among the 240,461 patients with BC, 14.3% had a second type.

Conclusion: Despite a significant decrease in the number of smokers in the United States between 2000 and 2016, the incidence of BC in men and LBC in women has not followed a similar decline. The odds ratio of a patient diagnosed with primary BC developing a second neoplasm is 3.3 times greater than that of a patient diagnosed with primary LBC.

Keywords: Bladder cancer; Bronchial cancer; Lung cancer; Smoking.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: We report a retrospective study of archived and fully anonymized data from the SEER and CDC databases. We followed all the required steps for the data release policy and data user agreement of the SEER and CDC. This project was evaluated and approved by the Príncipe Ethics Committee of Pequeno Principe College, Curitiba, Paraná, Brazil, and informed consent was waived. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of non-Hispanic white Americans (NHWAs) who smoked across all age groups. Each panel represents the incidence during the period (2000–2016) by U.S. state (95% confidence interval)
Fig. 2
Fig. 2
Bladder cancer (BC) incidence. Each panel represents the incidence during the period (2000–2016) by U.S. state (95% confidence interval). The bottom panel shows the overall incidence (males + females), while top panel represents the incidence stratified by sex
Fig. 3
Fig. 3
Lung-bronchial cancer (LBC) incidence. Each panel represents the incidence during the period (2000–2016) by U.S. state (95% confidence interval). The bottom panel shows the overall incidence (males + females), while top panel represents the incidence stratified by sex
Fig. 4
Fig. 4
Incidence of bladder cancer (BC; top panel) and lung-bronchial cancer (LBC; bottom panel) by age group. The incidence by age of diagnosis (per 100,000) was calculated for three age groups: 0–44, 45–64, and over 64 years
Fig. 5
Fig. 5
Locally Estimated Scatterplot Smoothing (LOESS). The red line represents the smoothing of the weighted local scatter plot for the recorded points of bladder cancer (BC) and lung-bronchial cancer (LBC) incidence.”
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