Germline mutations in CHEK2 have been associated with a range of cancer types but little is known about disease risks conveyed by CHEK2 mutations outside of the context of breast and prostate cancer. To investigate whether CHEK2 mutations confer an increased risk of bladder cancer, we genotyped 416 unselected cases of bladder cancer and 3,313 controls from Poland for 4 founder alleles in the CHEK2 gene, each of which has been associated with an increased risk of cancer at other sites. A CHEK2 mutation (all variants combined) was found in 10.6% of the cancer cases and in 5.9% of the controls (OR 5 1.9; 95%CI 1.3-2.7; p 5 0.0003). We conclude that CHEK2 mutations increase the risk of bladder cancer in the population. ' 2007 Wiley-Liss, Inc.Key words: bladder cancer; CHEK2; CHK2 germline mutations; susceptibility Urothelial bladder cancer is the second most common tumor of the genitourinary tract and has the highest recurrence rate of any cancer. In Poland 3,500 new cases of bladder cancer are diagnosed annually. Bladder cancer develops more predominantly in males and increases significantly in incidence between the ages of 60 and 70 years in the life. The risk factors for developing bladder cancer are: cigarette smoking, exposure to aromatic amines, polycyclic aromatic hydrocarbons and infection with Schistosoma haematobium. [1][2][3][4] There is evidence that some bladder cancers are a result of a genetic predisposition to disease. Several studies have reported an association of bladder cancer with polymorphisms in xenobiotic metabolizing enzymes. The glutathione S Transferase M1 (GSTM1) null phenotype has been implicated with bladder cancer and polymorphisms in the N-acetyl transferase 2 (NAT2) gene that result in slow acetylation have also been linked to bladder cancer but only in association with tobacco smoke exposure. 5 One of the most frequently disrupted chromosomes associated with bladder cancer development is chromosome 17. 6 Approximately 40% of bladder tumors are characterized by loss of heterozygosity (LOH) on the short arm of chromosome 17. One of the genes located in this region of loss is the p53 tumor suppressor gene. The p53 gene plays an important role in DNA repair as it encodes a 53Kd phosphoprotein, which is involved in the control and holding of cells in G1-S phase of the cell cycle. 6 The p53 protein interacts with the product of another tumor suppressor gene, CHEK2. 7,8 The CHEK2 gene (cell cycle checkpoint kinase2) is located on the long arm of chromosome 22. It is homologous to the protein kinases Cds1 and Rad53 found in Schizosaccharomyces pombe and Saccharomyces cerevisiae, respectively. 9 The Cds1/Rad53 proteins have been shown to be required for the response to various forms of DNA damage as has as CHEK2, which in mammalian cells is associated with an arrest of the cell cycle at G2 in response to DNA damage 10,11 such as DNA double strand breaks, the most lethal type of DNA damage.The causes of double stranded DNA breaks include exposure to environmental mutagens such as genotoxic c...