Bladder Cancer: Occupational Risk Factors

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Longterm exposure to certain chemicals and agents in the workplace can be a significant cause of bladder cancer so it’s important to be aware of professional environments where you may need added protection.

In this article we take a closer look at occupational bladder cancer and those professions that may be at higher risk. We then provide some practical tips that may help you reduce that risk.

What is occupational bladder cancer?

An ‘occupational cancer’ is any type of cancer that is wholly or partially caused by exposure to a cancer causing agent (carcinogen) in the workplace.

Evidence suggests occupational exposure is the second most common cause after smoking¹. Around 10% of all bladder cancer cases are thought to be ‘occupational’, and caused by exposure to cancer-causing agents at work¹. This makes bladder cancer one of the most common types of work-related cancers to be diagnosed, along with lung cancer and mesothelioma (a type of cancer that usually starts in the layers of tissue that cover each lung)².

How does occupational bladder cancer develop?

Most cases of occupational bladder cancer can be linked to long periods of time working with certain types of industrial chemicals. Prolonged exposure to chemicals or environmental risks that can repeatedly damage and cause changes to DNA in cells lining the bladder. Over time this may lead to tumor development, and bladder cancer.

It can take a long time for occupational bladder cancer to develop. Sometimes a diagnosis is not made until years or even decades after the individual has stopped working with potentially hazardous chemicals. Research suggests the average length of time between starting to work with potential bladder-cancer causing agents and developing bladder cancer can be as long as 20 to 30 years¹.

Occupational risk factors for bladder cancer

Evidence has linked several different types of industrial chemicals to higher risks of developing bladder cancer. These include complex hydrocarbons and other organic chemicals commonly used in manufacturing and other industrial processes, as well as various solvents, mineral oils, and other chemicals³.

Aromatic amines are a broad group of organic compounds which have a type of molecular structure called an ‘aromatic ring’. This structure helps them bind to and damage DNA, and they are thought to be a major cause of occupational bladder cancer. Unfortunately these chemicals are in widespread use in industrial and manufacturing processes, including metal, plastic, rubber, and textile manufacturing, and are also used in fungicides and pesticides, commercial hair dyes, vehicle exhaust, and cigarette smoke^1,4.

It’s important to note that exposure to these chemicals does not necessarily mean bladder cancer will develop. High exposure for prolonged periods of time is often necessary and, even then, the majority of those working with carcinogens may not develop the disease. However if you do work closely with chemicals on a day-to-day basis, it’s important to understand the risks, and look for ways to reduce your exposure. Read more about bladder cancer risk factors.

Examples of agents linked to higher-risk of bladder cancer	Examples of occupations with potential risk for exposure
Aromatic amines (i.e. 4-aminobipheyl, benzidine, 2-naphthylamine, ortho-toluidine)	Dyes and pigment manufacture, painters, metal plastic textile and rubber industries, pesticide and cleaning product users, possibly hairdressers and barbers.
Coal tars and pitches	Production of refined products, aluminum industry, road paving and construction.
Polyaromatic hydrocarbons (i.e. benzo[a]pyrene)	Working in close contact with burning matter- i.e. foundries, steel working, firefighters, mechanics.
Diesel engine exhaust	Professional drivers, mechanics.
Mineral oils	Lubricants, printing industry, cosmetics, pharmaceutical industries.
Solvents	Rubber industry, leather working industries.
Leather dust	Leather working industries.

Who is at risk of developing occupational bladder cancer?

Evidence suggests that certain professions which traditionally have had prolonged contact with high-risk carcinogens may be at an increased risk of developing occupational bladder cancer. Some of these professions include:

People who work in manufacturing and industrial processing. Workers involved in manufacturing rubber, textiles and leathers, plastics, mining and metals can regularly come into contact with high levels of bladder-cancer causing chemicals such as aromatic amines. Studies suggest people working in these industries could be at increased risk of developing occupational bladder cancer compared to the general population^1,5.
People who work with dyes. Dyes, including hair dyes, can contain a number of carcinogenic chemicals, and dye workers may have an increased risk of bladder cancer. There is evidence that suggests painters, hairdressers and barbers may be more likely to develop bladder cancer compared to the general population⁴.
Transport workers. Truck drivers, bus drivers, and people who are regularly exposed to high levels of diesel fumes may have a higher risk of developing occupational bladder cancer⁶.
Firefighters. Several studies suggest that firefighters may have an increased risk of bladder cancer, caused by regular exposure to various smoke and chemical fumes.
Other occupational groups. It can be difficult to pin down exact levels of risk for specific occupational groups, as many factors can be involved in a person’s individual risk profile. However, some evidence suggests that other professions which involve regular contact with known bladder cancer carcinogens, such as farmers, printers and dry cleaners, may also have an increased risk of developing bladder cancer.

The good news is that extensive research into the causes of occupational bladder cancer over the last few decades has helped to raise awareness of the disease leading to improved prevention practices at work, particularly in some of the highest-risk environments. This is helping to reduce rates of occupational bladder cancer in a number of professional groups¹.

That being said, research is still uncovering other chemicals and agents commonly used in the workplace that may increase a person’s risk to bladder cancer. For example, recent analysis has found evidence that the profile of occupations at greatest risk of occupational bladder cancer is changing, and could now affect women more than men¹.

Workplace chemical exposures have been linked to an estimated 25 of all bladder cancer cases. 1

Reducing your risk of occupational bladder cancer

If you are worried about your risk for occupational bladder cancer because you currently work in a setting which may increase your exposure to high-risk agents, there are many things you can do.

The first step is awareness - find out more about any personal workplace risk factors you may have. Resources at the bottom of this page can be a good starting place for this.

Health and safety regulations have improved enormously in recent years. Your workplace should notify you of any potential dangers, and follow strict regulations to help you reduce your contact with anything that may be a potential danger to your health. If you are unsure of specific preventative regulations and practices that may be in place at your work, it is always a good idea to check.

It is also always important to follow all workplace safety procedures in place to limit and avoid exposure, such as wearing protective clothing and taking part in any workplace screening activities.

You do have legal rights around this and if you suspect regulations and safety practices in this area are not being followed, it could mean having a difficult conversation with your employer, or supportive agencies outside of work. The National Institute for Occupational Safety and Health (NIOSH) has many resources around risk and your rights as a worker.

What to do if you are worried about your risk of bladder cancer

If you believe you’ve been exposed to occupational carcinogens over an extended period, you can also personally take action to help manage your risk. This might be particularly pertinent to you if you no longer work in a high-risk industry, but have identified that you may have had previous possible workplace exposure to risk factors.

Active steps you can take:

Watch out for common signs and symptoms. Blood in the urine is the most common symptom of bladder cancer, and is usually the first symptom noticed by patients. Discomfort and pain on urination, or changes in urination habits can also be early symptoms.
Talk to your doctor. It can be worth reaching out and having a conversation with your doctor about your worries, even if you have no signs or symptoms. You can ask questions about any current or past occupational risk factors for bladder cancer you might have identified, as well as any other possible issues.

Why it is important to detect bladder cancer early

Honest and open conversations with your doctor or healthcare professional at an early stage can help provide assurance, and can also make sure that you receive any tests or medical care you might need. Early detection of any potential problem is key to making sure that you can receive the best possible care and increase chances of a successful outcome.

Depending on your own individual risk profile and any symptoms you may have, you may undergo tests or a schedule of regular checks for reassurance, and to make sure any possible changes in the bladder are detected early.

These tests commonly include traditional investigations which involve imaging, cystoscopy (where a thin, flexible tube with a light and camera is inserted into the bladder) and sampling your urine for traces of blood or cancer cells.

Genomic urine tests, such as Cxbladder, are a newer non-invasive type of test which can measure gene expression in your urine. This genetic information is used to quickly and accurately rule out urothelial bladder cancer, reducing the need for further invasive procedures.
Learn more about Cxbladder Contact us for more information

References

Cumberbatch MGK, et al., JAMA Oncol. 2015;1(9):1282–1290 https://jamanetwork.com/journals/jamaoncology/fullarticle/2451427
CCOHS OHS Answers Factsheets: Occupational Cancer https://www.ccohs.ca/oshanswers/diseases/occupational_cancer.html
CCOHS OHS Answers Factsheets: Cancer Sites Associated with Occupational Exposures https://www.ccohs.ca/oshanswers/diseases/carcinogen_site.html
Letašiová S, et al., Environ Health 2012;11, S11. https://doi.org/10.1186/1476-069X-11-S1-S11
Bethwaite PB, et al., Br J Ind Med. 1990;47(11):742-746.
Reed O, et al., PLoS One. 2020 Oct 21;15(10):e0239338. https://doi.org/10.1371/journal.pone.0239338