Journal Article

Urinary pH, cigarette smoking and bladder cancer risk

Juan Alguacil, Manolis Kogevinas, Debra T. Silverman, Núria Malats, Francisco X. Real, Montserrat García-Closas, Adonina Tardón, Manuel Rivas, Montserrat Torà, Reina García-Closas, Consol Serra, Alfredo Carrato, Ruth M. Pfeiffer, Joan Fortuny, Claudine Samanic and Nathaniel Rothman

in Carcinogenesis

Volume 32, issue 6, pages 843-847
Published in print June 2011 | ISSN: 0143-3334
Published online March 2011 | e-ISSN: 1460-2180 | DOI:
Urinary pH, cigarette smoking and bladder cancer risk

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  • Clinical Cytogenetics and Molecular Genetics


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Glucuronide conjugates of 4-aminobiphenyl and its N-hydroxy metabolite can be rapidly hydrolyzed in acidic urine to undergo further metabolic activation and form DNA adducts in the urothelium. We conducted a large multicenter case–control study in Spain to explore the etiology of bladder cancer and evaluated the association between urine pH and bladder cancer risk, alone and in combination with cigarette smoking. In total, 712 incident urothelial cell carcinoma cases and 611 hospital controls directly measured their urine pH with dipsticks twice a day (first void in the morning and early in the evening) during four consecutive days 2 weeks after hospital discharge. We found that a consistently acidic urine pH ≤6.0 was associated with an increased risk of bladder cancer [odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.2–1.9] compared with all other subjects. Furthermore, risk estimates for smoking intensity and risk of bladder cancer among current smokers tended to be higher for those with a consistently acidic urine (OR = 8.8, 11.5 and 23.8) compared with those without (OR = 4.3, 7.7 and 5.8, respectively, for 1–19, 20–29 and 30+ cigarettes per day; Pinteraction for 30+ cigarettes per day = 0.024). These results suggest that urine pH, which is determined primarily by diet and body surface area, may be an important modifier of smoking and risk of bladder cancer.

Journal Article.  3516 words.  Illustrated.

Subjects: Clinical Cytogenetics and Molecular Genetics

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