INTRODUCTION AND OBJECTIVE: Environmental exposures are potential risk factors for bladder cancer (BCa). Agent Orange (AO) was an herbicide used during the Vietnam War and has subsequently been labeled as a probable human carcinogen with potential links to BCa. In this study, we explore the effect of AO exposure on BCa outcomes in patients receiving Bacille-Calmette Guerin (BCG) for nonmuscle invasive BCa (NMIBC).METHODS: We retrospectively examined the association between AO exposure in patients with NMIBC in national VA databases who were being treated with BCG. We chose to include only patients receiving BCG to focus on a more homogeneous patient population. Patients were diagnosed with NMIBC from 2000-2010 with follow-up through 2018. Clinical, pathological, and demographic variables were compared by AO exposure. Associations of AO exposure with overall survival, cancer-specific survival, and progression-free survival were performed using Cox proportional hazard models after inverse propensity score weighted (IPSW) and competing risks adjustments.RESULTS: Overall, 7,651 patients were identified of which 753 (9.8%) were exposed to AO. The median follow-up time was > 10 years in both groups. The AO exposed patients were younger (age 61 vs 71 years, p <0.001), but had similar Charlson comorbidity scores and stage/grade distribution as the non-AO exposed patients. After IPSW adjustment in our Cox multivariable analyses, AO exposure was not associated with worse overall survival (HR 1.07, 95% CI 0.91-1.27, p[0.41), cancer-specific survival (HR 1.31, p[0.13), or progression-free survival (HR 1.08, 95% CI 0.86-1.36, p[0.51).CONCLUSIONS: AO exposure was not associated with worse oncologic outcomes in patients receiving BCG for NMIBC. While this is reassuring, additional research is needed in other patient populations and disease states to determine if the effect is consistent.