There are a number of risk factors for the development of upper tract urothelial cancer (UTUC). Most of these risk factors are related to chronic exposure to carcinogens. This blog will focus on one of the more rare, but interesting dietary risk factors for UTUC, Aristolochic Acid. The other known risk factors for UTUC are:
- smoking - the most important modifiable risk factor
- coffee - higher risk of UTUC if >7 cups of coffee per day 
- not as big an impact if cigarette smoking is considered
- analgesics - phenacetin, caffeine, codeine, acetaminophen, and aspirin or other salicylates have all been implicated
- arsenic - discovered in Taiwan, where drinking wells are contaminated by arsenic; natives have a higher risk of Blackfoot Disease and UTUC, both believed to be caused by arsenic 
- occupation - chronic exposure to chemicals, dyes, asphalt, tar, petroleum and plastics
|The The Balkan Peninsula, popularly referred to as the Balkans, |
is a geographical region of Southeast Europe. The region takes
its name from the Balkan Mountains that stretch from
the east of Bulgaria to the very east of Serbia.
|China and Taiwan.|
|Aristolochia Plant Species, of which over 500 individual species exist. |
These plants are known for their strong scent and are often nicknamed
"Birtwort," referring to the birth canal-like shape of the plants.
- Aristolochic Acid is a risk factor for the development of UTUC through chronic dietary exposure.
- Laboratory studies demonstrate mechanisms by which AA exposure can cause cancer.
- Epidemiologic studies demonstrate increased risk of UTUC related to dietary exposure and not familial genetics.
- Countries of the Balkans and Eastern Asia are two areas in the world where AA ingestion can be considered an endemic cause of UTUC.