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 .
- Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2017; 3:524.
- Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67:7.
- Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87.
- Chou R, Dana T. Screening adults for bladder cancer: a review of the evidence for the U.S. preventive services task force. Ann Intern Med 2010; 153:461.
- Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet 2009; 374:239.
- Davis R, Jones JS, Barocas DA, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 2012; 188:2473.
- Britton JP, Dowell AC, Whelan P, Harris CM. A community study of bladder cancer screening by the detection of occult urinary bleeding. J Urol 1992; 148:788.
- Lotan Y, Roehrborn CG. Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and meta-analyses. Urology 2003; 61:109.
- Lotan Y, Elias K, Svatek RS, et al. Bladder cancer screening in a high risk asymptomatic population using a point of care urine based protein tumor marker. J Urol 2009; 182:52.
- Kuehhas FE, Weibl P, Tosev G, et al. Multidetector computed tomography virtual cystoscopy: an effective diagnostic tool in patients with hematuria. Urology 2012; 79:270.
- Qu X, Huang X, Wu L, et al. Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: a meta-analysis. Eur J Radiol 2011; 80:188.
- Messing EM, Madeb R, Young T, et al. Long-term outcome of hematuria home screening for bladder cancer in men. Cancer 2006; 107:2173.
- Madeb R, Golijanin D, Knopf J, et al. Long-term outcome of patients with a negative work-up for asymptomatic microhematuria. Urology 2010; 75:20.
- Mayfield MP, Whelan P. Bladder tumours detected on screening: results at 7 years. Br J Urol 1998; 82:825.
- Bangma CH, Loeb S, Busstra M, et al. Outcomes of a bladder cancer screening program using home hematuria testing and molecular markers. Eur Urol 2013; 64:41.
- Steineck G. Demographic and epidemiologic aspects of bladder cancer. In: Bladder Cancer Current Diagnosis and Treatment, Droller MJ (Ed), Humana Press Inc, Totowa, NJ 2001. p.1.
- Wu X, Lin J, Grossman HB, et al. Projecting individualized probabilities of developing bladder cancer in white individuals. J Clin Oncol 2007; 25:4974.
- Vickers AJ, Bennette C, Kibel AS, et al. Who should be included in a clinical trial of screening for bladder cancer?: a decision analysis of data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Cancer 2013; 119:143.
- Thériault GP, Tremblay CG, Armstrong BG. Bladder cancer screening among primary aluminum production workers in Quebec. J Occup Med 1990; 32:869.
- Marsh GM, Leviton LC, Talbott EO, et al. Drake Chemical Workers' Health Registry Study: I. Notification and medical surveillance of a group of workers at high risk of developing bladder cancer. Am J Ind Med 1991; 19:291.
- Marsh GM, Cassidy LD. The Drake Health Registry Study: findings from fifteen years of continuous bladder cancer screening. Am J Ind Med 2003; 43:142.
- Hemstreet GP 3rd, Yin S, Ma Z, et al. Biomarker risk assessment and bladder cancer detection in a cohort exposed to benzidine. J Natl Cancer Inst 2001; 93:427.
- Pesch B, Nasterlack M, Eberle F, et al. The role of haematuria in bladder cancer screening among men with former occupational exposure to aromatic amines. BJU Int 2011; 108:546.
- Moyer VA, U.S. Preventive Services Task Force. Screening for bladder cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2011; 155:246.
- http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20110819bladdercancer.html (Accessed on January 28, 2016).
- Bladder and other urothelial cancers screening. http://www.cancer.gov/types/bladder/patient/bladder-screening-pdq (Accessed on January 28, 2016).
- Babjuk M, Oosterlinck W, Sylvester R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 2011; 59:997.
- Kamat AM, Hegarty PK, Gee JR, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: Screening, diagnosis, and molecular markers. Eur Urol 2013; 63:4.
- American Cancer Society guidelines for the early detection of cancer. http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer (Accessed on January 28, 2016).
- 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