Although incidence rates of bladder cancer have declined slightly in recent years due to reduced smoking, overall disease burden is expected to rise through 2040, according to a modeling study published in European Urology Open Science.
Despite decades of public health efforts, bladder cancer remains expensive to manage due to high recurrence rates and the need for long-term surveillance and treatment.
Researchers developed three independent microsimulation models—COBRAS, Kystis, and SCOUT—under the Cancer Intervention and Surveillance Modeling Network to study the natural history of the disease, estimate lifetime risk and project its future burden.
The models were calibrated using national cancer registry data and simulated life histories of individuals born between 1900 and 2040. Focusing on White men, the group with the highest incidence, the study found that lifetime risk of bladder cancer diagnosis rose from about 2.4% in the 1910 cohort to 34.4% in those born in 2010. Most diagnoses occurred after age 61, and the models estimated that the window from when a tumor becomes detectable to clinical diagnosis was around 2 to 3 years
All models predicted a decline in age-standardized incidence by approximately 0.6% annually, reflecting reduced smoking. However, crude incidence and the absolute number of new cases are projected to increase by 1.5–1.8% per year due to an aging population. By 2040, models estimate between 45 and 52 new cases per 100,000 person-years
Modeling also revealed that early events in bladder cancer development, like tumor emergence and progression, occur over a wide age range and at variable rates. For white men born in 1950, the median age for initial lesion emergence was 74 years, and for muscle-invasive disease, 77 years. Median age of diagnosis ranged from 74 to 77 years across models.
The study highlights an incoming mismatch between growing demand and the shrinking urology workforce. With more than 30% of U.S. urologists aged 65 or older and a majority located in urban areas, access to specialist care may become more difficult.
“Our models project that the annual incidence of bladder cancer and new cases will increase at least through 2040. Increased exposure to environmental pollutants, vaping, and occupational and household carcinogens may accentuate these trends,” the authors wrote.
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