Screening for bladder cancer
- Steven C Campbell, MD, PhD
Steven C Campbell, MD, PhD
- Glickman Urological and Kidney Institute
- Cleveland Clinic
- J Stephen Jones, MD
J Stephen Jones, MD
- Glickman Urological and Kidney Institute
- Cleveland Clinic
- Section Editors
- Seth P Lerner, MD
Seth P Lerner, MD
- Section Editor — Bladder Cancer
- Beth and Dave Swalm Chair in Urologic Oncology
- Professor of Urology
- Baylor College of Medicine
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
Urothelial cell carcinoma of the bladder is the most frequently diagnosed cancer of the urinary tract other than prostate cancer, and its incidence has been slowly rising over the last several decades. When diagnosed early, the majority of bladder cancers are noninvasive. However, delayed diagnosis can be associated with high-grade muscle-invasive disease, which can quickly progress, metastasize, and become fatal.
Screening refers to the detection of asymptomatic disease by testing either the general population or a targeted population of individuals known to be at increased risk. Screening for bladder cancer offers the potential to diagnose the disease in an early stage when treatment can lead to cure, prolong survival, or significantly improve quality of life. However, it remains uncertain if screening can effectively achieve these goals.
Screening is to be contrasted with surveillance, which refers to ongoing testing to detect early recurrent disease in patients who have been previously diagnosed and treated for cancer. The issue of disease recurrence is of particular relevance for urothelial cancer. (See 'Natural history' below.)
The modalities that have been proposed for bladder cancer screening and results from the limited studies that have been conducted, will be reviewed here. An overview of the treatment of urothelial bladder cancer is presented separately. (See "Overview of the initial approach and management of urothelial bladder cancer".)
EPIDEMIOLOGY AND RISK FACTORS
Worldwide, there were approximately 540,000 cases of bladder cancer and 190,000 deaths related to bladder cancer . In the United States, there are approximately 79,000 cases per year and 17,000 deaths . There is a 10-fold variation in bladder cancer incidence internationally, with the highest rates in Europe, North America, Western Asia, and Northern Africa .
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- EPIDEMIOLOGY AND RISK FACTORS
- NATURAL HISTORY
- SCREENING MODALITIES
- Dipstick testing for hematuria
- Urine cytology
- Urine biomarkers
- STUDIES OF SCREENING EFFECTIVENESS
- Average-risk groups
- High-risk groups
- HARMS OF SCREENING
- RESEARCH GAPS
- RECOMMENDATIONS OF EXPERT GROUPS
- SUMMARY AND RECOMMENDATIONS