CANCER CHEMOPREVENTION (R AGARWAL, SECTION EDITOR) Targeting Inflammation for Bladder Cancer Chemoprevention Venkateshwar Madka 1,2 & Adam S. Asch 1 & Chinthalapally V. Rao 1 # Springer International Publishing AG 2017 Abstract Purpose of Review Cancer of the bladder is a serious health problem with significant mortality once it progresses to ad- vanced stages. Moreover, chronic surveillance and treatments are required to prevent the inherent high recurrence and ag- gressive nature of these tumors. As a result, not only the qual- ity of life for the patients is affected but it also adds to the treatment cost, making it one of the costliest cancers to treat. Therefore, it is highly imperative to consider preventive op- tions that have been largely neglected. Recent Findings Although smoking prevalence is decreasing, a decline in BC incidence has not been seen, yet suggesting that smoking history and other factors still pose a threat to develop BC. With the increase of diabetic and obese popula- tions, the risk for BC is also increasing. In spite of their mod- ifiable nature, advancement in diagnosis, understanding of the disease, and enormous preclinical chemoprevention data, ef- forts in that direction for screening and primary or secondary prevention of this disease have been unsatisfactory. Moreover, no new therapeutic were approved for the last three decades; thus, the 5-year survival of BC patients has also not improved for decades. Summary In the current review, we have discussed the central role of inflammation in the major risk factors such as smoking, diabetes, obesity, and infection leading to BC. We summa- rized the preclinical data of promising anti-inflammatory agents for primary, secondary, as well as tertiary prevention. Thus, we believe that developing chemopreventive strategies for bladder cancer by targeting inflammation is highly desirable. Keywords Bladder cancer . Inflammation . Chemoprevention . NSAIDs Introduction Bladder cancer (BC) is a global health problem affecting near- ly 430,000 people annually, making it the 9th most common cancer worldwide. More than one third of these patients (165,000) die each year [1]. Worldwide bladder cancer inci- dence trends indicate its direct correlation with the level of human development [2]. Data suggest that developed coun- tries have a threefold higher incidence of BC compared to less-developed nations (ASR of 9.5 and 3.3 per 100,000, re- spectively). In countries like Germany, there has been a sharp increase in BC cases among both men (35% increase) and women (75% increase) in the last three decades. There are several identified factors like age, gender, race, and genetics that increase the risk for BC. The incidence of bladder cancer increases with age with a majority of the BC diagnoses being among 50–70-year age groups of both sexes. Since the 1950s, the incidence of bladder cancer has risen by approximately 50%. It is to be anticipated that, with the aging of the population, this trend will continue. Furthermore, BC is cancer with a very high disparity based on gender. Males are at three to four times higher risk of developing BC compared to This article is part of the Topical Collection on Cancer Chemoprevention * Venkateshwar Madka vmadka@ouhsc.edu; cv-rao@ouhsc.edu 1 Center for Cancer Prevention and Drug Development, Hematology and Oncology, Department of Medicine, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA 2 University of Oklahoma HSC, 975 NE 10th Street, BRC 1209B, Oklahoma City, OK 73104, USA Curr Pharmacol Rep https://doi.org/10.1007/s40495-017-0116-z