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This process results in mutations, particularly in critical tumor suppressor genes like TP53, significantly elevating the risk of bladder cancer (Vineis and Pirastu, 1997

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173 Therefore, malignant cells shift from undertaking mitochondrial oxidative phosphorylation (OXPHOS) to invoking the glycolysis pathway, even under normal oxygen conditions with full and proper mitochondrial functioning, creating a pseudohypoxic state known as the Warburg effect

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