Dear Doctor: Half of bladder cancer cases are related to smoking, or secondhand smoke

DEAR DR. ROACH: Recently, to my surprise, I came down with bladder cancer. I am a healthy 66-year-old man who is 5 feet, 11 inches tall, 215 pounds, and a lifelong nonsmoker. I drink a few beers monthly and don’t take any meds.

It was very surprising that what was thought to be kidney stones came back as papillary noninvasive bladder cancer. They removed a Ta-T1 tumor that was less than 3 cm from the top of my bladder. I have recently started BCG (Bacillus Calmett-Guerin) treatments.

Until now, I hadn’t heard of bladder cancer; I was stunned to realize it’s the fourth most common cancer and can be fatal if it isn’t caught as early as mine was. Could you please explain this very common and deadly cancer? — T.S.

ANSWER: Bladder cancer is actually the 10th most common cancer worldwide but sixth in men, whereas it is three times as common as in women. The most common risk factor seems to be exposure to toxic chemicals, of which tobacco smoking is the most common. About half of bladder cancer is related to smoking, including secondhand smoke.

Occupational exposure is also well-documented, affecting workers who are involved in manufacturing metal, paint, plastics, and other industrial chemicals, as well as painters, leather workers, miners and others. A variety of genetic predispositions, such as Lynch syndrome, is also implicated in bladder cancer. Even so, 30% of people with bladder cancer have no identifiable risk.

Fortunately for you, a noninvasive cancer was found that was less than 3 cm, which is the best possible result for bladder cancer. Topical treatment (bladder infusion) with chemotherapy such as gemcitabine is the usual first-line treatment. You had BCG treatments (the same used for the tuberculosis vaccine), which stimulate the inflammatory and immune system to attack the cancer. This is very likely to effectively treat the cancer, but you will need lifelong surveillance and may need additional doses.

Screening for bladder cancer isn’t generally recommended.

DEAR DR. ROACH: I am a 69-year-old woman who gets occasional urinary tract infections (UTIs), especially when traveling or right after I get home. Would it be beneficial to take cranberry supplements prior to traveling and while traveling to help prevent this? — Anon.

ANSWER: Cranberry products have been shown to decrease the risk of recurrent UTIs. Either cranberry juice or cranberry concentrate tablets are effective. Since you get the infection when traveling, taking the supplements once or twice daily might help.

I wonder why you only get the UTIs around the time of travel. If you aren’t adequately hydrating yourself when you travel, you might be extra sure to drink additional water.

Any time I see postmenopausal women with UTIs, I consider the use of topical vulvovaginal estrogen. After menopause, estrogen levels go down, which tends to lead to the thinning of the vulva and the lining of the vagina. The bacteria in the area changes with the colonization of bacteria that predispose women to infection.

With topical estrogen, the vaginal flora returns back to the premenopausal stage with less E. coli — a common cause of infection. Estrogen, even topical, should be used with caution in a person with a history of estrogen-sensitive tumors or a person who is at a high risk for them.

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