Research News

07/17/2026

Cleveland Clinic identifies rising trend in young-onset bladder cancer

From bladder cancer in women to microplastics and cancer risk, one physician’s curiosity turned a concerning observation into a larger public health picture.

Two maps of Ohio, delineated by ZIP code. ZIP codes range from light blue to dark blue, with the darkest blue clusters in the northwest and southeast. Red circles of various sizes overlay the maps. On the left map, small and medium red circles cluster in the southwest and central parts of Ohio. On the right map, medium red dots cluster in the southwest and northeast, while very large red dots overlay the center of the state.

The blue represents bladder cancer incidence per 100,000 population by ZIP code across Ohio. Darker blue represents higher incidence. Red circles indicate relative levels of microplastics exposure in the air (left) and water (right) per 100,000 population by ZIP code. All data is from 2013-2021.

Bladder cancer has long been viewed as a disease of older men. So, physician oncologist Laura Bukavina, MD, MPH, was concerned when she started seeing more women and younger adults under 50 in her practice. Was this shift unique to patients from Cleveland? Were genetics involved, or maybe environmental factors?

In two papers published in Clinical Genitourinary Cancer and Urologic Oncology, Dr. Bukavina and her team set out to understand what she was seeing in the clinic.

“I wanted to see if this is just a bias to our institution...or if it's just something across the board that other people were seeing too,” she says.

Defining the problem

To find out, clinical research fellow Gabriela Diaz, MD, helped analyze patient data from a database of over 100 healthcare organizations across 20 countries. She paired her findings with genetic information from the UK B iobank.

Dr. Diaz’s analyses confirmed that the pattern Cleveland Clinic’s Urologic Oncology team was seeing was actually a global trend. Young-onset bladder cancer diagnoses are increasing worldwide, especially in women.

“It’s important to note that we did not show bladder cancer is uniquely becoming a women’s health issue,” Dr. Bukavina says. “But the demographics of this disease are radically changing from what would be expected based on the traditional view of bladder cancer as a disease that overwhelmingly affects older men.”

Dr. Diaz says that it’s important for physicians and patients to be aware of these demographic shifts, especially because early symptoms can mimic urinary tract infections. She hopes her findings will encourage physicians to keep a broader range of possibilities in mind when evaluating and diagnosing female or younger patients.

Figuring out why

After the team confirmed that bladder cancer demographics were changing, their focus shifted to asking what caused the change. Using the UK Biobank, Dr. Diaz looked for inherited genetic factors associated with young-onset bladder cancer. While she identified some potentially relevant variants, mutations were rare.

“A demographic shift this extreme doesn’t happen for no reason,” Dr. Bukavina says. “If it’s not inherited factors within the patient, it has to be something external.”

Devika Nandwana, MD, who recently graduated after working as a medical student researcher under Dr. Bukavina, led a team in exploring environmental changes that might help explain the increase in bladder cancer cases. The team used Ohio cancer registry data and Environmental Protection Agency emissions records to compare cancer incidences and chemical exposure levels across ZIP codes throughout the state.

Their analysis found that areas with greater exposure to microplastic emissions from factories had higher rates of young-onset bladder cancer diagnosis. The strongest associations were linked to the air in heavily industrialized regions of northern and southwestern Ohio, followed by water across the state.

Importantly, the study does not show that microplastics directly cause bladder cancer. Instead, it highlights geographic patterns that may help guide future research.

“This study itself isn't pointing to any specific cause of bladder cancer right now,” Dr. Bukavina says. “There is an association here, but we don’t know if there’s a causation.” Dr. Bukavina and her team are conducting studies to determine whether microplastics are truly part of the story they uncovered. Preclinical results have already been published in collaboration with other institutes.

Building a bigger picture

“Part of being a scientist is just about being curious,” Dr. Bukavina says. “If you have a question and you don't find the answer, you have the ability to at least try to get the answer. Sometimes those answers raise more questions. The more questions you answer, the more you see the big picture.”