Table of Contents
ISRN Pathology
Volume 2012, Article ID 283670, 7 pages
Clinical Study

Analysis of the Distribution and Temporal Trends of Grade and Stage in Urothelial Bladder Cancer in Northern New England from 1994 to 2004

1Department of Pathology, Dartmouth Medical School, Hanover, New Hampshire, NH 03756, USA
2Division of Cancer Epidemiology and Genetics, Science Applications International Corporation-Frederick, Inc., National Cancer Institute-Frederick, Frederick, MD 21702, USA
3Clinical Monitoring Research Program, Occupational and Environmental Epidemiology Branch, SAIC-Frederick, Inc., National Cancer Institute, 6120 Executive Plaza South, RM 8007, Rockville, MD 20852, USA
4Occupational and Environmental Epidemiology Branch, Epidemiology and Biostatistics Program, National Cancer Institute, NIH, DHHS, Bethesda, MD 20852, USA
5Vermont Cancer Registry, Burlington, Vermont, VT 05402, USA
6Department of Pathology and Laboratory Medicine, Maine Medical Center Portland, ME 04102, USA
7Department of Pathology, University of Vermont College of Medicine, Burlington, VT 05405, USA
8Maine Cancer Registry, Augusta, ME 04333, USA
9Department of Pathology and Laboratory Medicine, Brown University, Providence, RI 02912, USA
10Section of Biostatistics and Epidemiology, Dartmouth Medical School, Hanover, NH 03756, USA

Received 11 January 2012; Accepted 31 January 2012

Academic Editors: A. Handra-Luca, A.-J. Kruse, and A.-G. Selim

Copyright Β© 2012 Alan R. Schned et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We investigate the distribution of bladder tumor category and stage in Northern New England by geographic region, smoking status, and over time. 1091 incident bladder cancer cases from the New England Bladder Cancer Study (NEBCS), a large population-based case-control study carried out in Maine, New Hampshire, and Vermont (2001–2004) and 680 bladder cancer cases from previous case-control studies in New Hampshire (1994–2000) were used in the analysis. Of 1091 incident bladder cancer cases from the NEBCS, 26.7% of tumors were papillary urothelial neoplasms of low malignant potential (PUNLMP), 26.8% low-grade papillary urothelial carcinomas (PUC-LG), 31.3% high-grade papillary urothelial carcinomas (PUC-HG), 9.1% nonpapillary urothelial carcinomas (non-PUC), and 4.3% carcinoma in situ (CIS). Approximately 70% of cases were noninvasive (Tis/Ta), and all PUNLMP cases were of the Ta category. By contrast, half of all PUC-HG carcinomas were invasive. Short-term time trend analysis within the NEBCS (2001–2004) indicated an increase in the percentage of PUNLMP ( 𝑃 -trend <0.0001) paralleled by a decrease in PUC-LG ( 𝑃 -trend = 0.02) and for PUC-LG an increase in the percentage of non-invasive tumors ( 𝑃 -trend 0.04). Our findings suggest possible short-term trends with an increase in the percentage of PUNLMP and a change in the percentage of PUC-LG towards non-invasive disease.