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Biochemical Verification with Cotinine Needed to Accurately Identify Bladder Cancer Patients with Smoking Exposure, Study Suggests

There is a need for biochemical verification with cotinine or additional questions about other sources of nicotine to accurately identify non-muscle invasive bladder cancer (NMIBC) patients who have smoking-related exposures, according to a recent study.

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According to experts, cigarette smoking is correlated with the development of NMIBC and continued exposure following diagnosis may heightened the possibility of adverse clinical outcomes.

The cross-sectional analysis made a comparison between self-reported vs biochemically verified nicotine exposure to determine the accuracy of self-report among those recently diagnosed with NMIBC. There was a total of 517 NMIBC patients who contributed a urine or saliva specimen the same day as self-reporting their smoking, use of e-cigarettes, nicotine replacement therapy, and whether they lived with a smoker were included in the analysis.

Researchers used cotinine – a primary metabolite of nicotine, as an objective biomarker of recent nicotine exposure of the patient.

Prevalence of high, low, and no cotinine exposure was 13%, 54%, and 33% correspondingly. Among the patients, 38 (or 7.3%) reported being a current smoker, while 65 (or 13%) had cotinine levels consistent with active smoking exposure. However, 27 of these 65 patients denied smoking, leading to a sensitivity of self-reported current smoking of 58%.

The sensitivity rose to 82% after considering other sources of nicotine exposure such as e-cigarettes, cigars, nicotine replacement therapy, and living with a smoker. Majority of the patients with low cotinine denied any smoking-related exposure.

Researchers said that accurate classification of active and passive smoking exposure is essential to allow clinicians to advise cessation and help experts estimate the association between postdiagnosis smoking-related exposure and NMIBC recurrence risk.


Source: J Urol 2021;205:1321-1325

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