Ultrasound verification of bladder damage is associated with known biomarkers of bladder cancer in adults chronically infected with Schistosoma haematobium in Ghana

Abstract

Long-term infection with urinary schistosomiasis has been associated with development of bladder cancer. However, bladder cancer is difficult to diagnose without invasive measures such as cystoscopy, thus there is little information on the epidemiological extent of the problem. Studies have been either case-control studies or case examinations in different geographical areas, estimating a schistosome-associated bladder cancer incidence of 3-4 cases per 100,000. We have used three indicators to examine the potential bladder cancer problem in an adult rural population in Ghana endemic for urinary schistosomiasis: (i) parasitological positivity; (ii) age prevalence of bladder damage from ultrasound scans; and (iii) detection of biomarkers associated with the presence of bladder cancer. Biomarkers were BLCA-4 test (urine) and nuclear morphometry or quantitative nuclear grading (QNG) of epithelial cells (urine sediment), which quantifies DNA ploidy status and nuclear morphometric descriptors, both of which can detect the presence of bladder cancer. Our data show an increasing association between age, severe bladder abnormalities and the occurrence of these biomarkers. Sixty-two of 73 cytopathology Papanicolaou-stained smears were seen to have squamous metaplasia. Although further investigations are needed, we suggest that schistosome-associated bladder cancer is an important public health concern in areas where Schistosoma haematobium is prevalent.

The role of estrogens and estrogen receptor signaling pathways in cancer and infertility: the case of schistosomes

“…The epidemiological association between SCC of the bladder with schistosomiasis haematobia is based both on case control studies and on the correlation of bladder cancer incidence with prevalence of S. haematobium infection within diverse geographic locations. The incidence of urogenital schistosomiasis-associated SCC is estimated in 3-4 cases per 100 000 [34]. Schistosomiasis haematobia is a chronic infection.…”

Tumour-like phenotypes in urothelial cells after exposure to antigens from eggs of Schistosoma haematobium: An oestrogen–DNA adducts mediated pathway?

“…The severity and frequency of the sequelae of urinary schistosomiasis and of its complications (urothelial cancers) depend on the intensity of infection (worm burden and tissue egg burden) and the duration of infection (Hodder et al, 2000;Herrera et al, 2005). A S. haematobium-associated bladder cancer incidence of 3-4 cases per 100,000 has been estimated (Shiff et al, 2006). Felix et al (2008) showed that the occurrence of transitional cell carcinoma (TCC) of the bladder has supplanted SCC in Egypt following a major decline in the prevalence of urinary schistosomiasis.…”

Bladder Cancer and Urinary Schistosomiasis in Angola

“…Lesions in urinary tract caused by S. haematobium in sub-Saharan Africa are characterized by signs and symptoms like haematuria, dysuria and hipogastralgy, and in advanced stages can evolve to cancer [6,7]. Ultrasound analysis permits the detection of alterations of urinary tract, kidneys (hydronephrosis), as well as lesions and presence of “sandy patches” in the vesical wall [1,7,8]. …”