Zusammenfassung
Das Blasenkarzinom ist mit 8,6% der vierthäufigste Tumor beim Mann und mit 3,5% der achthäufigste Tumor bei der Frau. Das Interesse an der Primärprävention des Blasenkarzinoms wurde durch die Cole-Studie geweckt, nach der Kaffeetrinken ein Risiko darstellen soll. Dies ist durch 42 Fall-Kontroll-Studien widerlegt. Zigarettenrauchen erhöht das Blasenkarzinomrisiko um den Faktor 3. Verantwortlich sind u. a. Arylamine, die in der Leber aktiviert, aber auch entgiftet werden. Ein genetisch bedingter Mangel an den notwendigen Transferasen ist für jedes 3. Blasenkarzinom verantwortlich. Auch beim Haarfärben wird ein Arylamin aufgenommen, das in Leber und Haut durch Transferasen entgiftet werden muss. Auch hier ist ein genetischer Mangel für eine mögliche Blasenkarzinomentstehung mit verantwortlich. Der 3. Risikofaktor ist der chronische Harnweginfekt. Somit spielt die Reduktion von Risikofaktoren die wesentliche Rolle in der Blasenkarzinomprävention.
Eine hohe Flüssigkeitszufuhr in Form von Getränken jeder Art halbiert das Blasenkarzinomrisiko und sollte dem Raucher (das relative Risiko fällt auf 0,31) empfohlen werden. Ein Zusammenhang zwischen Alkoholzufuhr und Blasenkarzinom ist nicht bewiesen.
Vitamin A, B und C wurden intensiv in epidemiologischen Studien untersucht. Ein Nutzen für die Blasenkarzinomprimärprävention ist nicht schlüssig bewiesen. Interessant ist die Blasenkarzinomvorbeugung durch Folsäure in der Nahrung beim Raucher. Früchte und Gemüse haben auf einen Nenner gebracht eine schwache vorbeugende Wirkung. Allerdings kann der reichlich Obst verzehrende Raucher sein Risiko halbieren.
Das Spurenelement Selen hat keine gesicherte Schutzwirkung, aber die Inzidenz des Blasenkarzinoms ist bei hohem Selenplasmaspiegel signifikant erniedrigt. Unter den Probiotika ist Lactobacillus-casei-haltiger Joghurt nach einer Studie zur Primärprävention besonders beim Raucher geeignet. NSAR haben insgesamt eine schwache Wirkung. Überraschend ist die Beobachtung, dass regelmäßiger Analgetikagebrauch das Blasenkarzinomerkrankungsrisiko senkt.
Abstract
Bladder cancer (Bc) with an incidence of 8.6% ranks fourth in males and with an incidence of 3.5% ranks eighth in females in Germany. The study of Cole demonstrating that coffee drinking poses a risk for developing Bc raised interest in primary prevention. In the meantime, however, 42 case-control studies could disprove this finding. Cigarette smoking raises the Bc risk threefold. Responsible are among others arylamines which are activated in the liver, but also detoxified. A genetically caused lack of transferases is responsible for every third Bc. Another risk factor is contributed by permanent hair dyes. Similarly to smoking, an arylamine is taken up by the body and has to be detoxified by transferases in the liver and skin. Furthermore, a chronic urinary tract infection may be related to Bc. Thus, the best prevention is the reduction of risk factors.
A high fluid intake – irrespective of its kind – reduces the Bc risk by approximately 50%. Particularly smokers should realize that they can lower their risk of developing Bc by almost 70% with a high fluid intake. A connection between alcohol consumption and Bc development has never been shown.
Vitamins A, B, and C were extensively investigated in epidemiological studies. Usefulness for primary prevention of Bc was not convincingly demonstrated. Interestingly, folic acid-containing food may reduce the Bc risk for smokers. Fruits and vegetables possess only a weak preventive efficacy. However, copious fruit consumption may reduce the risk for smokers by almost 50%.
The trace element selenium does not possess a proven protection; however, it has been shown that persons with a high selenium plasma level have a lower incidence of Bc. Among probiotics yogurt containing Lactobacillus casei is particularly useful in smokers according to one study. Finally, the preventive action of NSAIDs is controversial. Surprisingly, users of analgetics have a low incidence of Bc.
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Altwein, J. Primärprävention des Blasenkarzinoms. Urologe 46, 616–621 (2007). https://doi.org/10.1007/s00120-007-1348-z
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DOI: https://doi.org/10.1007/s00120-007-1348-z