In the United States, an estimated 74,000 new cases of bladder cancer and 16,000 deaths occur annually. Because of favorable survival, approximately 578,000 persons are alive after diagnosis. Recurrence after treatment is common, necessitating lifelong surveillance and care, making bladder cancer the most costly malignancy from diagnosis to death. The median age at diagnosis has increased from 67 years in 1980 to 73 years in 2008–2012. Incidence rates rise dramatically with age, suggesting that as the US population ages, the burden of bladder cancer in the United States will continue to grow. Worldwide over 1.3 million cases are estimated to occur annually. Cigarette smoking is the principal known cause of bladder cancer, along with various chemical exposures. Recent studies suggest that, over the past two decades, the risk for current smokers has increased from three times the risk of nonsmokers to about four to five times the nonsmoker risk.