Bladder cancer is one of the most common cancers worldwide, yet it often receives far less attention than other smoking-related cancers. According to the GLOBOCAN global cancer fact sheet, bladder cancer is among the top 10 most frequently diagnosed cancers globally, with more than half a million new cases diagnosed each year worldwide. It occurs significantly more often in men than in women, and the risk rises steadily with age.

While some risk factors, such as age, sex, and genetic background, cannot be changed, smoking remains the single most important preventable cause of bladder cancer worldwide.

Why smoking is so strongly linked to bladder cancer

Many people associate smoking mainly with lung cancer, but the bladder is also directly exposed to tobacco toxins. When someone smokes, harmful chemicals from cigarette smoke enter the bloodstream. The kidneys filter these substances, and they are then excreted into the urine. As urine is stored in the bladder, the bladder lining is repeatedly exposed to these carcinogens over time.

Global data show that around 50 percent of people diagnosed with bladder cancer are current or former smokers. There are studies that even people who do not smoke themselves but are regularly exposed to secondhand smoke have a higher risk compared with non-exposed individuals.

Smoking increases bladder cancer risk by:

• Damaging the DNA of bladder cells.
• Causing long-lasting inflammation of the bladder lining.
• Reducing the immune system’s ability to detect and remove abnormal cells.

Over years, this cumulative damage can lead to cancer development.

Are e-cigarettes safer for the bladder?

Electronic cigarettes are often marketed as a safer alternative to traditional smoking, but evidence is increasingly raising concerns. Studies have detected potentially harmful substances from e-cigarette aerosols in urine, meaning the bladder is still exposed to toxic compounds. While long-term data are still limited, e-cigarettes cannot currently be considered harmless for bladder health.

How bladder cancer is usually detected

The most common warning sign of bladder cancer is blood in the urine, which is often painless and may appear intermittently. Other symptoms can include frequent urination, urgency, or discomfort during urination. Diagnosis usually involves urine tests, imaging, and a cystoscopy, a procedure that allows doctors to look directly inside the bladder.

Smoking history often plays a role not only in who develops bladder cancer, but also in how aggressive the disease appears at diagnosis.

Quitting smoking helps, even after diagnosis.

A crucial message for patients is this: It is never too late to quit smoking.

Research shows that:

• About 10 years after quitting, the risk of developing bladder cancer is reduced by up to 50 percent.
• After 20-25 years, the risk approaches that of people who never smoked.
• Patients who continue smoking after bladder cancer treatment have a higher chance of the cancer coming back compared with those who quit.

Quitting smoking improves both cancer-specific outcomes and overall health.

Smoking cessation is part of treatment, not just advice

From a medical perspective, stopping smoking should be seen as part of bladder cancer treatment, not merely lifestyle advice. Patients who receive clear education and support to quit smoking tend to have better long-term outcomes, lower recurrence rates, and improved quality of life.

For this reason, many urologists now consider smoking cessation counseling as essential as surgery, medications, and follow-up care.

A final message for patients

Bladder cancer is strongly linked to smoking, but this also means there is real opportunity for prevention and better outcomes. Quitting smoking lowers the risk of developing bladder cancer, reduces the chance of recurrence, and improves long-term survival, even after diagnosis.

If you smoke and notice blood in your urine, seek medical attention promptly. And if you have already been diagnosed with bladder cancer, remember that stopping smoking is one of the most powerful steps you can take for your recovery and future health.

Martina Ambardjieva is a dedicated urologist and medical educator with extensive experience in both clinical practice and academic instruction. She earned her MD from the University “Sv. Kiril i Metódij” in Skopje and is a PhD candidate in urological oncology, with a focus on bladder carcinoma. Her scholarly work includes numerous publications in oncologic urology, urinary calculosis, and men’s health.

Dr. Ambardjieva currently serves as a urologist at the PHI University Surgical Clinic “Naum Ohridski” and completed her residency training at the University Urology Clinic in Skopje. Earlier in her career, she practiced as a general medical doctor at Sante Plus General Hospital and completed a medical internship at the University of Ljubljana.

In addition to her clinical responsibilities, Dr. Ambardjieva is a teaching assistant at the Medical Faculty in Skopje. She works additionally as a collaborator for Dr. Telx. She has held leadership positions in the European Medical Students’ Association and actively participates in international medical education and policy. She has attended numerous congresses and workshops in France, Italy, Canada, and Turkey, and serves as a delegate for the European Association of Urology (EAU), contributing to cross-border initiatives in urology. Certified in laparoscopic surgery, she continues to integrate patient care, research, and education in her professional work.