e13564 Background: Many cancers have well-known association with the use of tobacco products. Cancers of lung, esophagus, head and neck, urinary tract including bladder, kidney, pancreas, cervix, etc. have proven causation to tobacco use. This study highlights the close association of the use of tobacco products to bladder cancer and emphasizes the need for increased public awareness in this regard. Methods: Data were collected from the medical records of patients treated during a five-year period (2012-2017). Three hundred sixty-two (362) biopsy proven bladder cancers were analyzed retrospectively. The association of bladder cancer to tobacco use was established and presented. Results: Three hundred sixty-two pathology proven bladder cancers were studied. Eighty percent (80%) of the occurrences were in men and twenty percent (20%) were in women. Twenty-five percent (25%) of the events were multiple occurrences in same patients. The most common histology was urothelial (transitional cell) cancer. A majority, eighty-one percent (81%) had a history of using tobacco products. Only thirteen percent (13%) were non-smokers. However, several of the non-smokers had exposure to secondary smoking or to chemicals of uncertain nature. About six percent (6%) of the cases had no definitive documentation of their risk factors. Conclusions: Bladder cancer is the ninth most common malignancy in the United States. Urothelial carcinoma is the most common histology. The most important risk factors are the use of tobacco products and exposure to certain environmental factors. More than sixty known carcinogens in tobacco smoke are attributed as the casual factors. Field cancerization is one of the hypotheses that account for multiple occurrences of urothelial cancer. The risk due to tobacco use is associated in 50%-65% in men and 20%-30% in women, which triples the incidences of malignancies as compared to non-smokers. Although, the public are well aware of the association of the use of tobacco products with cancers, such as lung, esophagus, and head and neck, there is less awareness that it is also a casual factor for bladder cancer. This study stresses the importance of this conclusion and the need to create a wide spread awareness among the public on the use of tobacco products as a cause for bladder cancer in both men and women.