N-Nitroso compounds (NOCs) have been proposed as possible bladder carcinogens. The main sources of exogenous exposure to NOCs are cigarette smoke and diet, particularly processed (i.e., nitrite-treated) meats. Perhaps more importantly, NOCs can be formed endogenously from dietary precursors such as nitrate, nitrite and amines. Heme has been shown to increase endogenous nitrosation. We examined the role of dietary sources of NOCs and NOC precursors as potential bladder cancer risk factors using data from the Los Angeles Bladder Cancer Study, a population-based case-control study. Dietary and demographic information was collected from 1,660 bladder cancer cases and 1,586 controls via a structured questionnaire. Intake of liver and of salami/pastrami/corned beef, were both statistically significantly associated with risk of bladder cancer in this study, particularly among nonsmokers. Heme intake was also statistically significantly associated with risk of bladder cancer among nonsmokers only. When considering NOC precursors, risk was consistently higher among subjects with concurrent high intake of nitrate and high intake of the different meats (sources of amines and nitrosamines). Results of this study are consistent with a role of dietary sources of NOC precursors from processed meats in bladder cancer risk, suggesting consumption of meats with high amine and heme content such as salami and liver as a risk factor for bladder cancer. In addition, any effect of consuming these meats may be greater when accompanied by high nitrate intake.Bladder cancer is the sixth most common cancer worldwide and is predominantly a disease of high-income countries such as the US, where it is now the third most common malignancy. 1 Identified risk factors include white race, male gender, some occupational exposures and a history of smoking tobacco, with smoking accounting for nearly 50% of all bladder cancer cases in the US. 2,3 The role of diet in bladder cancer is only partially understood. Epidemiological evidence has supported a protective role for diets high in calcium, yellow-orange vegetables, citrus fruits and cruciferous vegetables, although, the WCRF recently downgraded this protective role from probable to inconclusive. 4 Diets high in meats, especially processed meats, diets high in fat and intake of artificial sweeteners have been implicated as risk factors for bladder cancer, but these results are inconclusive. 5,6 N-Nitroso compounds (NOCs) have been proposed as possible bladder carcinogens. In particular, the NOC dibutylnitrosamine is metabolized in the liver and passes through the bladder where its metabolites can be absorbed and activated in the bladder mucosa. 7 These metabolites have been demonstrated to induce bladder tumors in mice and rats. 8,9 The main sources of exogenous exposure to NOCs are cigarette smoke and diet, in particular processed meats such as cold cuts, sausage and bacon, when nitrate or nitrite salts are added to meat as part of the processing. 10,11 A proportion of