In a case-control study published in BMCCancer on 1 October 2015, researchers aimed to assess the relationship between metabolic syndrome and bladder cancer risk. The study included a total of 690 patients with uroepithelial carcinoma of the bladder and 665 patients without cancer. It was found that patients with the metabolic syndrome had a more than 2-fold increased risk of bladder cancer compared to those without the syndrome (OR, 2.20; 95% CI: 1.38-3.19). Further analysis found that the ORs for bladder cancer in patients with diabetes, hypertension, hypercholesterolaemia and abdominal obesity were 2.20 (95% CI: 1.42-3.38), 0.88 (95% CI: 0.66-1.17), 1.16 (95% CI: 0.80-1.67) and 1.63 (95% CI: 1.22-2.19) respectively. . There was no significant heterogeneity in the risk of bladder cancer by gender, age, education, region, and smoking habits. Overall, 8.1% (95% CI: 3.9%-12.4%) of bladder cancer cases could be attributed to the metabolic syndrome. The results of this study suggest that the metabolic syndrome is associated with an increased risk of bladder cancer. It is known that an increased incidence of several cancers has been detected in patients with diabetes and obesity. Some scholars have suggested that circulating mitogenic factors (or growth-promoting factors) may be the culprit, including insulin. Although insulin has been shown not to be a carcinogen, it is possible that it is a potential catalyst for preformed tumours. However, this remains a highly controversial area. This study suggests that metabolic syndrome can lead to a more than two-fold increase in bladder cancer risk. Much of this is caused by diabetes, but interestingly, we also note that an increased number of metabolic syndrome components is associated with a further increased risk of bladder cancer in patients. At this point, mechanistic insights can only be speculative; however, the current study may provide us with a clue as to why observational studies have found an association between thiazolidinedione pioglitazone treatment and bladder cancer risk. As insulin sensitizers are often used in patients with insulin resistance features (e.g. metabolic syndrome), it is not surprising that more pioglitazone treated patients develop bladder cancer. This may not be due to the drug itself, but may be related to the patient characteristics that led to the drug being prescribed, also known as channeling bias. Of interest, a recent 10-year study by Dr Lewis and others found that initial concerns about pioglitazone and the risk of bladder cancer were in fact unfounded.
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