Tobacco smoking is known as the common risk factor which has an association with bladder cancer. However, there’s still less clarity on the prognosis of bladder cancer.

For the examination of associations between tobacco use, e-cigarettes, and marijuana with recurrence risk and progression of non-muscle-invasive bladder cancer (NMIBC) and to explore the usage of smoking cessation interventions.

The prospective cohort patient study with NMIBC diagnosis from 2015 to 2019 followed-up for 26.4 months in the integrated health care system at Kaiser Permanente Northern and Southern California.

In the study, the hazard ratio (HRs) and 95% CIs of progression and recurrence of bladder cancer were estimated by multivariable Cox proportional hazards regression.

In about 1472 patients (mean [SD] age at diagnosis, 70.2 [10.8%] years; 1129 [76.7%] male patients) with NMIBC were enrolled at the mean (SD) of 2.3 (1.3) months after the diagnosis. It included 874 patients, 111 (7.5) patients who are current cigarette smokers, (59.4%) former smokers. About 65 (4.4%) patients used e-cigarettes while 67 (13.7%) patients smoked pipes or cigars only. Around 363 patients (24.7%) used marijuana. 

Long cigarette smoking duration and more pack-years had an association with the high risk of recurrence in the dose-dependent manner. It included the high risk for the patients who smoked for 40 years or more (HR, 2.36; 95% CI, 1.43-3.91) or 40 or more pack-years (HR, 1.97; 95% CI, 1.32-2.95). There wasn’t any association of having smoked ever, being a current or former cigarette smoker, and years since quit smoking with the risk of reucrrence. 

Lack of association with marijuana, e-cigarettes, cigars, or pipes found. About 102 patients were offered a smoking cessation intervention, 57 (53.8%) received an intervention after diagnosis. Female patients were more engaged than the male patients in such interventions (23 of 30 female patients [76.7%] vs 34 of 76 male patients [44.7%]; P = .003).

The findings suggest that with the longer duration and more pack-years of cigarette smoking, there was an association with a high risk of NMIBC recurrence. Cigarette smoking has been a critical exposure after and before the diagnosis in the survivors of NMIBC.