Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran

Maryam Hadji; Hamideh Rashidian; Maryam Marzban; Abbas Rezaianzadeh; Alireza Ansari-Moghaddam; Mahdieh Bakhshi; Azim Nejatizadeh; Monireh Sadat Seyyedsalehi; Ahmad Naghibzadeh-Tahami; AliAkbar Haghdoost; Elham Mohebbi; Neal D Freedman; Reza Malekzadeh; Arash Etemadi; Farin Kamangar; Elisabete Weiderpass; Eero Pukkala; Paolo Boffetta; Kazem Zendehdel

doi:10.1158/1055-9965.EPI-23-0773

Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran

Maryam Hadji
, Hamideh Rashidian
, Maryam Marzban
, Abbas Rezaianzadeh
, Alireza Ansari-Moghaddam
, Mahdieh Bakhshi
, Azim Nejatizadeh
, Monireh Sadat Seyyedsalehi
, Ahmad Naghibzadeh-Tahami
, AliAkbar Haghdoost
, Elham Mohebbi
, Neal D Freedman
, Reza Malekzadeh
, Arash Etemadi
, Farin Kamangar
, Elisabete Weiderpass
, Eero Pukkala
, Paolo Boffetta
, Kazem Zendehdel

Health Sciences

Research output: Contribution to journal › Article › Scientific › peer-review

2 Citations (Scopus)

13 Downloads (Pure)

Abstract

BACKGROUND: Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern.

METHODS: We used the IROPICAN database in Iran and employed multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer.

RESULTS: We analyzed 717 cases and 3477 controls and a subset of 215 patients and 2145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 (95% CI: 0.69, 1.20), we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR=1.78, 95% CI 1.16, 2.72) compared to non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR=2.25, 95% CI: 1.21, 4.18) and for initiating waterpipe smoking at an age less than 20 (OR=2.73, 95% CI 1.11, 6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR=2.35, 95% CI 1.24-4.42) than in current smokers (OR=1.52, 95% CI 0.72-3.15). All observed associations were consistently higher for urothelial histology.

CONCLUSIONS: Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium.

IMPACT: The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers.

Original language	English
Pages (from-to)	509-515
Number of pages	7
Journal	Cancer Epidemiology Biomarkers and Prevention
Volume	33
Issue number	4
DOIs	https://doi.org/10.1158/1055-9965.EPI-23-0773
Publication status	Published - 3 Apr 2024
Publication type	A1 Journal article-refereed

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SDG 3 Good Health and Well-being

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10.1158/1055-9965.EPI-23-0773Licence: CC BY-NC-ND

epi-23-0773Final published version, 240 KBLicence: CC BY-NC-ND

https://urn.fi/URN:NBN:fi:tuni-202402192337Licence: CC BY-NC-ND

Cite this

Hadji, M., Rashidian, H., Marzban, M., Rezaianzadeh, A., Ansari-Moghaddam, A., Bakhshi, M., Nejatizadeh, A., Seyyedsalehi, M. S., Naghibzadeh-Tahami, A., Haghdoost, A., Mohebbi, E., Freedman, N. D., Malekzadeh, R., Etemadi, A., Kamangar, F., Weiderpass, E., Pukkala, E., Boffetta, P., & Zendehdel, K. (2024). Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran. Cancer Epidemiology Biomarkers and Prevention, 33(4), 509-515. https://doi.org/10.1158/1055-9965.EPI-23-0773

@article{810664bc85004e8d96d9497326e1202d,

title = "Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran",

abstract = "BACKGROUND: Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern.METHODS: We used the IROPICAN database in Iran and employed multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer.RESULTS: We analyzed 717 cases and 3477 controls and a subset of 215 patients and 2145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 (95\% CI: 0.69, 1.20), we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR=1.78, 95\% CI 1.16, 2.72) compared to non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR=2.25, 95\% CI: 1.21, 4.18) and for initiating waterpipe smoking at an age less than 20 (OR=2.73, 95\% CI 1.11, 6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR=2.35, 95\% CI 1.24-4.42) than in current smokers (OR=1.52, 95\% CI 0.72-3.15). All observed associations were consistently higher for urothelial histology.CONCLUSIONS: Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium.IMPACT: The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers.",

author = "Maryam Hadji and Hamideh Rashidian and Maryam Marzban and Abbas Rezaianzadeh and Alireza Ansari-Moghaddam and Mahdieh Bakhshi and Azim Nejatizadeh and Seyyedsalehi, \{Monireh Sadat\} and Ahmad Naghibzadeh-Tahami and AliAkbar Haghdoost and Elham Mohebbi and Freedman, \{Neal D\} and Reza Malekzadeh and Arash Etemadi and Farin Kamangar and Elisabete Weiderpass and Eero Pukkala and Paolo Boffetta and Kazem Zendehdel",

year = "2024",

month = apr,

day = "3",

doi = "10.1158/1055-9965.EPI-23-0773",

language = "English",

volume = "33",

pages = "509--515",

journal = "Cancer Epidemiology Biomarkers and Prevention",

issn = "1055-9965",

publisher = "American Association for Cancer Research Inc.",

number = "4",

}

Hadji, M, Rashidian, H, Marzban, M, Rezaianzadeh, A, Ansari-Moghaddam, A, Bakhshi, M, Nejatizadeh, A, Seyyedsalehi, MS, Naghibzadeh-Tahami, A, Haghdoost, A, Mohebbi, E, Freedman, ND, Malekzadeh, R, Etemadi, A, Kamangar, F, Weiderpass, E, Pukkala, E, Boffetta, P & Zendehdel, K 2024, 'Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran', Cancer Epidemiology Biomarkers and Prevention, vol. 33, no. 4, pp. 509-515. https://doi.org/10.1158/1055-9965.EPI-23-0773

TY - JOUR

T1 - Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk

T2 - A Multicenter Case-Control Study in Iran

AU - Hadji, Maryam

AU - Rashidian, Hamideh

AU - Marzban, Maryam

AU - Rezaianzadeh, Abbas

AU - Ansari-Moghaddam, Alireza

AU - Bakhshi, Mahdieh

AU - Nejatizadeh, Azim

AU - Seyyedsalehi, Monireh Sadat

AU - Naghibzadeh-Tahami, Ahmad

AU - Haghdoost, AliAkbar

AU - Mohebbi, Elham

AU - Freedman, Neal D

AU - Malekzadeh, Reza

AU - Etemadi, Arash

AU - Kamangar, Farin

AU - Weiderpass, Elisabete

AU - Pukkala, Eero

AU - Boffetta, Paolo

AU - Zendehdel, Kazem

PY - 2024/4/3

Y1 - 2024/4/3

N2 - BACKGROUND: Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern.METHODS: We used the IROPICAN database in Iran and employed multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer.RESULTS: We analyzed 717 cases and 3477 controls and a subset of 215 patients and 2145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 (95% CI: 0.69, 1.20), we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR=1.78, 95% CI 1.16, 2.72) compared to non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR=2.25, 95% CI: 1.21, 4.18) and for initiating waterpipe smoking at an age less than 20 (OR=2.73, 95% CI 1.11, 6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR=2.35, 95% CI 1.24-4.42) than in current smokers (OR=1.52, 95% CI 0.72-3.15). All observed associations were consistently higher for urothelial histology.CONCLUSIONS: Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium.IMPACT: The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers.

AB - BACKGROUND: Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern.METHODS: We used the IROPICAN database in Iran and employed multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer.RESULTS: We analyzed 717 cases and 3477 controls and a subset of 215 patients and 2145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 (95% CI: 0.69, 1.20), we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR=1.78, 95% CI 1.16, 2.72) compared to non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR=2.25, 95% CI: 1.21, 4.18) and for initiating waterpipe smoking at an age less than 20 (OR=2.73, 95% CI 1.11, 6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR=2.35, 95% CI 1.24-4.42) than in current smokers (OR=1.52, 95% CI 0.72-3.15). All observed associations were consistently higher for urothelial histology.CONCLUSIONS: Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium.IMPACT: The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers.

U2 - 10.1158/1055-9965.EPI-23-0773

DO - 10.1158/1055-9965.EPI-23-0773

M3 - Article

C2 - 38180357

SN - 1055-9965

VL - 33

SP - 509

EP - 515

JO - Cancer Epidemiology Biomarkers and Prevention

JF - Cancer Epidemiology Biomarkers and Prevention

IS - 4

ER -

Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran

Abstract

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