Annual incidence in the United States is about 80,470 cases with 17,670 deaths. Median age is 65 years. Smoking accounts for 50% of the risk. Exposure to polycyclic aromatic hydrocarbons increases the risk, especially in slow acetylators. Risk is increased in chimney sweeps, dry cleaners, and those involved in aluminum manufacturing. Chronic cyclophosphamide exposure increases risk ninefold. Schistosoma haematobium infection also increases risk, especially of squamous histology.