Long‐term outcome of hematuria home screening for bladder cancer in men

Abstract

BACKGROUND.The objectives of this study were to determine whether bladder cancer (BC) screening in healthy men could lead to earlier detection and reduced BC mortality compared with unscreened men and to determine long‐term outcomes of a geographically defined, unscreened population with newly diagnosed BC.METHODS.In 1987 and from 1998 to 1992, 1575 men ages 50 years and older who were solicited from well patient rosters in clinics in and around Madison, Wisconsin, tested their urine repetitively with a chemical reagent strip for hemoglobin. Participants who had positive test results underwent standard urologic evaluation. BC grades and stages and the outcomes of men with BC detected by screening were compared with the grades, stages, and outcomes of 87% of men ages 50 years and older with newly diagnosed BC who were reported to the Wisconsin Tumor Registry in 1988 (n = 509 men).RESULTS.Two hundred fifty‐eight screening participants (16.4%) were evaluated for hematuria, and 21 participants (8.1%) were diagnosed with BC. Proportions of low‐grade (Grade 1 and 2) superficial (Stage Ta and T1) versus high‐grade (Grade 3) superficial or invasive (Stage ≥ T2) cancers in screened men (52.4% vs. 47.7%) and in men from the tumor registry (60.3% vs. 39.7%) were similar (P = .50). The proportion of high‐grade superficial or invasive BCs that were invasive were lower in screened men (10%) than in unscreened men (60%; P = .002). At 14 years of follow‐up, no men with screen‐detected BC had died of BC, whereas 20.4% of men with unscreened BC had died of BC (P = .02).CONCLUSIONS.Screening effected the early detection of BC and may reduce mortality from BC compared with BC that is diagnosed at standard clinical presentation. Cancer 2006. © 2006 American Cancer Society.

The origins of bladder cancer

“…75 Repeat home urine dipstick testing followed by medical evaluation of positive patients may achieve 90-95% sensitivity. 76 With the home hematuria testing protocol, newly diagnosed patients with bladder cancer had muscle invasion in only 10% of cases, as opposed to 60% in newly diagnosed bladder cancer patients who had not been screened for hematuria. 76 This translated into lower disease-specific and overall mortality than unscreened patients.…”

“…76 With the home hematuria testing protocol, newly diagnosed patients with bladder cancer had muscle invasion in only 10% of cases, as opposed to 60% in newly diagnosed bladder cancer patients who had not been screened for hematuria. 76 This translated into lower disease-specific and overall mortality than unscreened patients. Unfortunately, the positive-predictive value of hematuria is only 0.08%.…”

Bladder Cancer in 2010: How Far have We Come?

“…Messing et al found that detecting microscopic hematuria by using repetitive home hematuria reagent-strip testing was an effective means of identifying bladder cancer at noninvasive stages and found a decreased mortality rate due to bladder cancer in the screened cohort at 14-year follow-up. 8 On the basis of findings such as these, a randomized, prospective, screening trial is warranted to further explore the role of screening in the detection of bladder cancer.…”

NMR-based Metabolomic Analysis of Human Bladder Cancer

“…It has been shown that widespread screening could decrease mortality from the disease. 2 The current standards of care for detecting and monitoring BC are cystoscopy, voided urine cytology and imaging. 3 Given the cost and invasive nature of such diagnostic techniques, looking for sensitive and specific biomarkers, as well as noninvasive early detection tests for BC, becomes an urgent subject.…”