Most smokers with bladder cancer are aware that using tobacco increased their risk of disease, a new study finds. More than half of bladder cancers in the United States are caused by smoking.

“Bladder cancer is actually the second most common smoking-related cancer, second only to lung,” lead author Dr. Jeffrey C. Bassett of Kaiser Permanente Southern California in Anaheim told Reuters.

Previous studies suggested most bladder cancer patients did not understand the connection between their disease and tobacco, he noted. “Bladder cancer patients smoking at diagnosis appear to accept that their own smoking caused their cancer, positioning them for a more motivated (and more likely successful) attempt at quitting,” Bassett said.

The study included 790 bladder cancer patients who completed a survey about their smoking history. About half had quit smoking. Many had given up smoking at least 10 years before they were diagnosed with cancer. The survey listed 10 potential causes of bladder cancer and asked participants to identify those that could cause cancer. They were also asked to identify which factors caused their own cancer.

Overall, almost 70 percent said tobacco could cause cancer, the researchers reported in the journal Cancer. Ninety percent of current smokers were aware of the link, compared with 64 percent of former smokers and 61 percent of those who had never smoked.

Quitting smoking after a cancer diagnosis can prolong survival, improve a patient’s prognosis, and decrease the risk of developing second cancers, according to a journal news release.