Primary prevention of bladder cancer: Does the public know the risk factors?

366 Background: Smoking is the single most significant modifiable risk factor for bladder cancer, yet this is not well known outside of the medical community. Previous studies from tertiary referral centers have found that 36-58% of urology patients can identify smoking as a risk factor for bladder cancer. Since those patients may not be representative of the general population, we studied the knowledge base of bladder cancer risk factors among people encountered in the general waiting room of an urban county hospital. Methods: 215 participants over 18 years of age were recruited from the waiting room of an urban county hospital to participate in a brief survey on risk factors for various cancers. Fisher’s exact test and McNemar’s test were used to detect differences in knowledge between bladder cancer and other cancers. Results: The survey participant population was mostly female (65.6%), Hispanic (54%), and middle-aged (67% age 35-64). Most (54.8%) had an annual household income of less than $20,000, attained a high school education (49.1%) or below (24.1%), and 40.3% were current or former smokers. An overwhelming majority of participants chose smoking as a risk factor for lung cancer (92.2%), with 80.7% identifying smoking as the primary risk factor for lung cancer. In contrast, only 31.6% of participants chose smoking as a risk factor for bladder cancer with 7.4% selecting it as the primary risk factor for bladder cancer. Knowledge of smoking as a risk factor for bladder cancer was not impacted by education, income, smoking status, or personal/family history of cancer. Male gender and exposure to industrial chemicals were identified as risk factors for bladder cancer by a minority of patients (19.3% and 28.0%, respectively). Almost half of all participants surveyed (49.1%) incorrectly identified alcohol use as a risk factor for bladder cancer. Conclusions: Among participants of low socioeconomic status presenting to an urban county hospital, there is a concerning lack of knowledge about the major risk factors for bladder cancer. Given that smoking is a modifiable risk factor, future public education initiatives to prevent bladder cancer should focus on populations with low socioeconomic status as high-yield targets to affect change.