Screening for bladder cancer: the best opportunity to reduce mortality

Abstract

Bladder cancer kills more women than cervical cancer and is alsoa significant cause of mortality in men. Little progress has beenmade in improving survival in patients with advanced bladdercancer. Two pilot studies using microhematuria screening haveshown that screening for bladder cancer results in close to 80%downstaging, with high-grade cancers being detected before theyhave invaded the bladder wall. Results of long-term follow-upeven suggest a striking reduction in bladder cancer mortality. Themain obstacles to screening for bladder cancer may be overcomeif a higher-risk population is identified by designing a risk scalefor exposure to cigarette smoke and occupational carcinogens,and through genetic testing for susceptibility to cancer and homehematuria screening, which in itself identifies a population withapproximately 3% to 4% risk of bladder cancer. The feasibilityand cost effectiveness of screening for bladder cancer can besignificantly improved by incorporating a secondary screeningstrategy using a more sensitive and specific bladder cancer markerthat is currently available, and by limiting urological evaluationsto patients who show positive results on one or more of thesetests. Bladder cancer is the most costly cancer to treat in theUnited States and pharmacoeconomic studies suggest that screeningfor bladder cancer could not only save lives but also reducecosts per year-life saved. A pilot study is underway and the urologycommunity should be very supportive of studies to validatethis opportunity.