Dietary sources of N-nitroso compounds and bladder cancer risk: Findings from the Los Angeles bladder cancer study

N-Nitroso compounds (NOCs) have been proposed as possible bladder carcinogens. The main sources of exogenous exposure to NOCs are cigarette smoke and diet, particularly processed (i.e., nitrite-treated) meats. Perhaps more importantly, NOCs can be formed endogenously from dietary precursors such as nitrate, nitrite and amines. Heme has been shown to increase endogenous nitrosation. We examined the role of dietary sources of NOCs and NOC precursors as potential bladder cancer risk factors using data from the Los Angeles Bladder Cancer Study, a population-based case-control study. Dietary and demographic information was collected from 1,660 bladder cancer cases and 1,586 controls via a structured questionnaire. Intake of liver and of salami/pastrami/corned beef, were both statistically significantly associated with risk of bladder cancer in this study, particularly among nonsmokers. Heme intake was also statistically significantly associated with risk of bladder cancer among nonsmokers only. When considering NOC precursors, risk was consistently higher among subjects with concurrent high intake of nitrate and high intake of the different meats (sources of amines and nitrosamines). Results of this study are consistent with a role of dietary sources of NOC precursors from processed meats in bladder cancer risk, suggesting consumption of meats with high amine and heme content such as salami and liver as a risk factor for bladder cancer. In addition, any effect of consuming these meats may be greater when accompanied by high nitrate intake. What's new? The role of diet in bladder cancer is only partially understood. Here the authors investigate the role of dietary sources of N-nitroso compounds (NOCs) in bladder cancer risk, taking into account both ingestion of preformed NOCs as well as the often overlooked role of endogenous NOC formation. NOCs can be formed endogenously from dietary precursors like nitrate, nitrite and amines. Based on a population-based case-control study, the findings support a role for dietary precursors of endogenous NOC formation as risk factors for bladder cancer, suggesting an additional route of carcinogenic exposure in the bladder that deserves consideration and further study.