Bladder Cancer Burden in the USA: Population Scenarios for 2040

Background and objective: Bladder cancer is the sixth most common cancer among men and is expensive to manage. We independently developed three microsimulation models that describe its natural history and explain epidemiological trends. We projected bladder cancer burden in the USA through 2040 to inform workforce planning. Methods: We calibrated the models to the Surveillance, Epidemiology and End Results (SEER) program incidence data and standardized key inputs. For White men, the highest-incidence subgroup, the models inferred unobservable epidemiological metrics, including lifetime risks by birth cohort and ages of the key events in the natural history. We simulated individual life histories under calibrated parameter sets and summarized the outcomes as yearly rates and counts. Key findings and limitations: Each model's predictions reproduced SEER age- and stage-specific incidence data. Across models, the lifetime risk of bladder cancer grew from approximately 1.5-2.4% in the 1910 to 3.1-4.4% in the 2010 birth cohorts, consistent with longevity and smoking exposure patterns. Of the cancer cases, 75% instantiate after ages 61-64 yr. The median model durations from when a cancer is screen detectable to its clinical manifestation were 2.1-3.3 yr, with a wide range across individuals. Through 2040, the incidence standardized to the 2000 US population declined by 0.4-0.6%/yr (consistent with the declining smoking rates, the most important environmental risk factor), but the annual incidence and new cases increased by 1.5-1.8%/yr (because the baby boomer population is living longer). Modeling supplements incomplete data with assumptions, but similar findings across independent models suggest some robustness to assumptions. Conclusions and clinical implications: Projected cohort longevity and smoking patterns imply an increased disease burden in the future, which may benefit from commensurate increased research and resources. From the inferred natural history, we speculate a theoretical opportunity for screening, which should be investigated with dedicated modeling and empirical studies. Patient summary: Three computer simulation models predicted the future incidence of bladder cancer burden in White men, in whom this cancer is most common. The models found that although the future incidence of bladder cancer would decrease slightly over time (consistent with the declining smoking rates, the most important environmental risk factor), the overall disease burden increased because the baby boomer population is living longer.