Urothelial cancer represents one of the most frequent neoplasms of the genitourinary tract. Its most common manifestations include urothelial carcinoma of the bladder, which constitutes more than 90% of bladder cancers in Western countries. Numerous studies have identified a significant correlation between advanced age and increased risk of developing this disease. In particular, often overlooked urinary changes may prove to be early indicators of an ongoing neoplastic process. This article aims to provide an overview of risk factors with a focus on age, integrating the epidemiologic perspective and discussing the importance of screening strategies targeting the over-60 population.

Urothelial cancer affects the transitional epithelium lining the entire urinary tract, from the renal pelvis to the urethra. Major risk factors include:

- Cigarette smoking (responsible for more than 50% of cases).
- Occupational exposure to chemicals (e.g., aromatic amines).
- Chronic urinary tract infections.
- Family history of urothelial tumors.

However, one of the factors most consistently associated with the incidence of the disease is age.

According to data from theInternational Agency for Research on Cancer (IARC) and major Italian cancer registries (AIRTUM), the incidence of urothelial cancer increases significantly after age 60. Approximately 70 percent of newly diagnosed cases occur in the over-65 age group.

1. Accumulation of somatic mutations: with advancing age, cells in the urothelium undergo an increasing amount of DNA damage.
2. Reduction in repair mechanisms: cellular defense systems become less efficient.
3. Prolonged exposure to carcinogens: the cumulative effect of exposure to toxic substances throughout life (e.g., smoking, environmental toxins).
4.Comorbidities: chronic diseases and drug therapies that can alter urine composition and inflame the urinary tract.

In the case of an elderly person, urinary symptoms are often attributed to benign disorders (e.g., prostatic hypertrophy, recurrent urinary infections). However, it is essential to consider some alarm bells:

- Hematuria (presence of blood in urine), even microscopic.
- Persistent urinary urgency and pollakiuria.
- Suprapubic or lumbar pain.
- Malodorous urine or recurrent abnormal coloration.

Early identification of these symptoms can make a difference in prognosis.

Currently, there is no universal screening program for urothelial carcinoma, but several studies suggest the usefulness of a selective approach in high-risk individuals, particularly males over 60, smokers or former smokers, and workers exposed to carcinogens. Active surveillance, with annual or biennial checkups in at-risk individuals, could be an effective strategy to anticipate diagnosis. In this context, the Urine 24 urine cytology test can be used both as a targeted screening tool and for surveillance of patients at risk because of its ability to detect cellular changes indicative of urothelial neoplasia even in the absence of symptoms.

With the progressive aging of the population, the epidemiological burden of urothelial cancer is likely to increase. Early detection, together with primary prevention (smoking cessation, reduction of exposure to carcinogens) and surveillance of urinary symptoms, is a crucial lever to contain the impact of the disease on the health care system.

Advanced age is a significant independent risk factor for the development of urothelial cancer. In an epidemiological context where the over-60 population is growing, it is critical to increase awareness among physicians and patients of the importance of monitoring seemingly trivial urinary signs. Urine, often underestimated as a source of clinical information, can instead ''tell'' the beginning of an oncologic process. n proactive approach, based on targeted screening, personalized risk assessments, and the use of tools such as the Urine 24 urine cytology test, can contribute decisively to improving early diagnosis and therapeutic outcomes.