Why does Rhode Island have the greatest incidence of bladder cancer in the United States?

For years, Rhode Island (RI) has had the greatest incidence of bladder cancer in the United States for both men and women. In fact, compared with the United States (US) overall, all of the New England states and New Jersey have disproportionately elevated bladder cancer rates. (Figure 1) From 2002-2006, the age-adjusted incidence of bladder cancer for men was 53.1/100,000 in Rhode Island versus 37.4/100,000 in the US; for women, it was 13/100,000 versus 9.4/ 100,000, respectively.1 (Table 1) In the US, urothelial (transitional cell) carcinoma accounts for about 90% of all bladder cancers. Less commonly, bladder neoplasms may be squamous cell (5%), adenocarcinoma (2%), and rarely small cell, lymphoma, or sarcoma. Because urothelial carcinoma is the predominant form of bladder cancer in the US and in RI, this review will focus on the epidemiology and risk factors of urothelial bladder carcinoma and some potential causes for the regional disparities.