Prolonged or intense cigarette smoking increases the risk of nonmuscle-invasive bladder cancer (NMIBC) recurrence, a new study finds.

“Cigarette smoking remains a critical exposure before and after diagnosis in survivors of NMIBC,” Marilyn L. Kwan, PhD, of Kaiser Permanente Northern California in Oakland, and colleagues wrote.

In the Be Well study, the investigators probed recurrence and progression risk among 1472 patients newly diagnosed with NMIBC (mean age at diagnosis, 70.2 years; 76.7% male). Of the cohort, 59.4% were former and 7.5% were current cigarette smokers. Another 13.7% of patients smoked cigars or pipes only, 4.4% used e-cigarettes, and 24.7% used marijuana (edible, smoking, etc). Overall, 39.1% of patients received chemotherapy and 52.2% received immunotherapy.

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Patients who had smoked cigarettes for 40 or more years or at least 40 cigarette pack-years had significant 2.4- and 2.0-fold increased risks of NMIBC recurrence within 2 years, respectively, compared with patients who smoked less than 10 years or 10 pack-years, Dr Kwan and colleagues reported in JAMA Network Open. Current smoking status and years since quitting were not associated with recurrence risk.

The investigators found no significant correlations between other tobacco, e-cigarette, or marijuana use with recurrence risk. They also found no significant associations between any smoking parameter and risk of NMIBC progression.

According to Dr Kwan’s team, “early and frequent smoking cessation interventions should be high priority in patients with NMIBC.” Along with a bladder cancer diagnosis, urologist advice is a motivator for smoking cessation, they noted.

In an exploratory analysis of smoking cessation interventions, a greater proportion of women than men with NMIBC (76.7% vs 44.7%) received a prescription medication, attended wellness coaching, or otherwise participated in an intervention.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Kwan ML, Haque R, Young-Wolff KC, et al. Smoking behaviors and prognosis in patients with non-muscle-invasive bladder cancer in the Be-Well study. JAMA Netw Open. Published online November 30, 2022. doi:10.1001/jamanetworkopen.2022.44430