Skip to content
My WebMD Sign In, Sign Up

Bladder Cancer Health Center

Font Size

Bladder and Other Urothelial Cancers Screening (PDQ®): Screening - Health Professional Information [NCI] - Description of the Evidence

continued...

The outcomes of men diagnosed with bladder cancer through a hematuria home screening program using a chemical reagent strip were compared with a statewide population-based sample of 87% of all men aged 50 years and older from the Wisconsin tumor registry.[49] Histologic sections were blindly reviewed, and similar proportions of low-grade superficial versus high-grade or invasive cases were found; the proportion of late-stage (T2 or higher) disease was lower in the screened patients. At 14 years, 20.4% of tumor registry patients had died from bladder cancer (including 50% of those with muscle-invading grade III lesions); however, at 14 years of follow-up, no participant with bladder cancer detected by screening had died of bladder cancer. Whether these differences resulted from some combination of lead-time effect, overdiagnosis, or selection biases, a real screening effect cannot be determined.

The measurement of a variety of molecules and cellular elements screened in urine has been proposed, and in some cases marketed, to monitor previously diagnosed bladder cancer patients; however, the specificity and sensitivity of these markers have not been assessed in a screening setting in a general population, but several such studies are under way.

Special Populations

In populations at particularly high risk for developing bladder cancer (other than those with histories of bladder cancer), few screening studies that have assessed bladder cancer mortality have been published.[67,68,69,70] A study of annual cytology in aluminum workers exposed to coal tar pitch in Quebec showed a nearly 40% reduction in bladder cancer case-fatality 6 years after diagnosis, compared with a historical control group of workers from the same plants who were not screened;[71] the difference, however, was not statistically significant. Awareness of adverse outcome in the unscreened predecessors may have influenced participation in the program and workers' awareness of symptoms, the willingness of workers and physicians to initiate diagnostic investigations based on signs and symptoms, and the compliance of workers with medical recommendations for evaluation and treatment. The brief duration of follow-up in the screened group may have artifactually improved the outcome.

No randomized controlled bladder cancer screening trials have been conducted in environmentally or industrially exposed cohorts. Completed studies have usually not had comparable control groups, have not been of sufficient sample size to show an effect on outcome, and have been of insufficient length to show a mortality benefit (or lack thereof) for the modality or modalities being assessed.[68,69] One study described the usefulness of measuring three biomarkers in voided urine for risk assessment and cancer detection in a large cohort of Chinese workers at increased risk of bladder cancer.[72] The workers were individually stratified, screened, monitored, and diagnosed on the basis of predefined molecular biomarker profiles. These techniques remain investigational.

References:

  1. American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online. Last accessed March 13, 2013.
  2. Howlader N, Noone AM, Krapcho M, et al., eds.: SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). Bethesda, Md: National Cancer Institute, 2012. Also available online. Last accessed February 21, 2013.
  3. Messing EM: Urothelial tumors of the urinary tract. In: Walsh PC, Retik AB, Vaughan ED, et al., eds.: Campbell's Urology. 8th ed. Philadelphia: Saunders, 2002, pp 2732-2773.
  4. Morrison AS: Advances in the etiology of urothelial cancer. Urol Clin North Am 11(4): 557-566, 1984.
  5. Burch JD, Rohan TE, Howe GR, et al.: Risk of bladder cancer by source and type of tobacco exposure: a case-control study. Int J Cancer 44 (4): 622-8, 1989.
  6. Clavel J, Cordier S, Boccon-Gibod L, et al.: Tobacco and bladder cancer in males: increased risk for inhalers and smokers of black tobacco. Int J Cancer 44 (4): 605-10, 1989.
  7. Hoffmann D, Masuda Y, Wynder EL: Alpha-naphthylamine and beta-naphthylamine in cigarette smoke. Nature 221: 254-256, 1969.
  8. Risch A, Wallace DM, Bathers S, et al.: Slow N-acetylation genotype is a susceptibility factor in occupational and smoking related bladder cancer. Hum Mol Genet 4 (2): 231-6, 1995.
  9. Horn EP, Tucker MA, Lambert G, et al.: A study of gender-based cytochrome P4501A2 variability: a possible mechanism for the male excess of bladder cancer. Cancer Epidemiol Biomarkers Prev 4 (5): 529-33, 1995 Jul-Aug.
  10. Bell DA, Taylor JA, Paulson DF, et al.: Genetic risk and carcinogen exposure: a common inherited defect of the carcinogen-metabolism gene glutathione S-transferase M1 (GSTM1) that increases susceptibility to bladder cancer. J Natl Cancer Inst 85 (14): 1159-64, 1993.
  11. Lower GM Jr, Nilsson T, Nelson CE, et al.: N-acetyltransferase phenotype and risk in urinary bladder cancer: approaches in molecular epidemiology. Preliminary results in Sweden and Denmark. Environ Health Perspect 29: 71-9, 1979.
  12. Cartwright RA, Glashan RW, Rogers HJ, et al.: Role of N-acetyltransferase phenotypes in bladder carcinogenesis: a pharmacogenetic epidemiological approach to bladder cancer. Lancet 2 (8303): 842-5, 1982.
  13. Hanke J, Krajewska B: Acetylation phenotypes and bladder cancer. J Occup Med 32 (9): 917-8, 1990.
  14. Morrison AS, Cole P: Epidemiology of bladder cancer. Urol Clin North Am 3 (1): 13-29, 1976.
  15. Steineck G, Plato N, Norell SE, et al.: Urothelial cancer and some industry-related chemicals: an evaluation of the epidemiologic literature. Am J Ind Med 17 (3): 371-91, 1990.
  16. King WD, Marrett LD: Case-control study of bladder cancer and chlorination by-products in treated water (Ontario, Canada). Cancer Causes Control 7 (6): 596-604, 1996.
  17. Stadler WM: Molecular events in the initiation and progression of bladder cancer (review). Int J Oncol 3: 549-557, 1993.
  18. Cole P, Hoover R, Friedell GH: Occupation and cancer of the lower urinary tract. Cancer 29 (5): 1250-60, 1972.
  19. Cosyns JP: Aristolochic acid and 'Chinese herbs nephropathy': a review of the evidence to date. Drug Saf 26 (1): 33-48, 2003.
  20. Chang CH, Wang YM, Yang AH, et al.: Rapidly progressive interstitial renal fibrosis associated with Chinese herbal medications. Am J Nephrol 21 (6): 441-8, 2001 Nov-Dec.
  21. Kessler DA: Cancer and herbs. N Engl J Med 342 (23): 1742-3, 2000.
  22. Liou SH, Lung JC, Chen YH, et al.: Increased chromosome-type chromosome aberration frequencies as biomarkers of cancer risk in a blackfoot endemic area. Cancer Res 59 (7): 1481-4, 1999.
  23. Moore LE, Smith AH, Hopenhayn-Rich C, et al.: Decrease in bladder cell micronucleus prevalence after intervention to lower the concentration of arsenic in drinking water. Cancer Epidemiol Biomarkers Prev 6 (12): 1051-6, 1997.
  24. Sturgeon SR, Hartge P, Silverman DT, et al.: Associations between bladder cancer risk factors and tumor stage and grade at diagnosis. Epidemiology 5 (2): 218-25, 1994.
  25. Hamid R, Bycroft J, Arya M, et al.: Screening cystoscopy and biopsy in patients with neuropathic bladder and chronic suprapubic indwelling catheters: is it valid? J Urol 170 (2 Pt 1): 425-7, 2003.
  26. Delnay KM, Stonehill WH, Goldman H, et al.: Bladder histological changes associated with chronic indwelling urinary catheter. J Urol 161 (4): 1106-8; discussion 1108-9, 1999.
  27. Lucas SB: Squamous cell carcinoma of the bladder and schistosomiasis. East Afr Med J 59 (5): 345-51, 1982.
  28. O'Keane JC: Carcinoma of the urinary bladder after treatment with cyclophosphamide. N Engl J Med 319 (13): 871, 1988.
  29. Tuttle TM, Williams GM, Marshall FF: Evidence for cyclophosphamide-induced transitional cell carcinoma in a renal transplant patient. J Urol 140 (5): 1009-11, 1988.
  30. Durkee C, Benson R Jr: Bladder cancer following administration of cyclophosphamide. Urology 16 (2): 145-8, 1980.
  31. Cohen SM, Garland EM, St John M, et al.: Acrolein initiates rat urinary bladder carcinogenesis. Cancer Res 52 (13): 3577-81, 1992.
  32. Habs MR, Schmähl D: Prevention of urinary bladder tumors in cyclophosphamide-treated rats by additional medication with the uroprotectors sodium 2-mercaptoethane sulfonate (mesna) and disodium 2,2'-dithio-bis-ethane sulfonate (dimesna). Cancer 51 (4): 606-9, 1983.
  33. Duncan RE, Bennett DW, Evans AT, et al.: Radiation-induced bladder tumors. J Urol 118 (1 Pt 1): 43-5, 1977.
  34. Sella A, Dexeus FH, Chong C, et al.: Radiation therapy-associated invasive bladder tumors. Urology 33 (3): 185-8, 1989.
  35. Quilty PM, Kerr GR: Bladder cancer following low or high dose pelvic irradiation. Clin Radiol 38 (6): 583-5, 1987.
  36. Buzzeo BD, Heisey DM, Messing EM: Bladder cancer in renal transplant recipients. Urology 50 (4): 525-8, 1997.
  37. Kantor AF, Hartge P, Hoover RN, et al.: Urinary tract infection and risk of bladder cancer. Am J Epidemiol 119 (4): 510-5, 1984.
  38. Locke JR, Hill DE, Walzer Y: Incidence of squamous cell carcinoma in patients with long-term catheter drainage. J Urol 133 (6): 1034-5, 1985.
  39. Fraumeni JF Jr, Thomas LB: Malignant bladder tumors in a man and his three sons. JAMA 201(7): 97-99, 1967.
  40. Aherne G: Retinoblastoma associated with other primary malignant tumours. Trans Ophthalmol Soc U K 94(4): 938-944, 1974.
  41. McCullough DL, Lamma DL, McLaughlin AP 3rd, et al.: Familial transitional cell carcinoma of the bladder. J Urol 113 (5): 629-35, 1975.
  42. Lynch HT, Ens JA, Lynch JF: The Lynch syndrome II and urological malignancies. J Urol 143 (1): 24-8, 1990.
  43. Kiemeney LA, Moret NC, Witjes JF, et al.: Familial aggregation of transitional cell carcinoma of the urinary tract. [Abstract] Proceedings of the American Urological Association 155(suppl): A-1520, 691a, 1996.
  44. Shipley WU, Kaufman DS, McDougal WS: Cancer of the bladder. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1168-85.
  45. Varkarakis MJ, Gaeta J, Moore RH, et al.: Superficial bladder tumor. Aspects of clinical progression. Urology 4 (4): 414-20, 1974.
  46. Sultana SR, Goodman CM, Byrne DJ, et al.: Microscopic haematuria: urological investigation using a standard protocol. Br J Urol 78 (5): 691-6; discussion 697-8, 1996.
  47. Khadra MH, Pickard RS, Charlton M, et al.: A prospective analysis of 1,930 patients with hematuria to evaluate current diagnostic practice. J Urol 163 (2): 524-7, 2000.
  48. Carmack AJ, Soloway MS: The diagnosis and staging of bladder cancer: from RBCs to TURs. Urology 67 (3 Suppl 1): 3-8; discussion 8-10, 2006.
  49. Messing EM, Young TB, Hunt VB, et al.: Comparison of bladder cancer outcome in men undergoing hematuria home screening versus those with standard clinical presentations. Urology 45 (3): 387-96; discussion 396-7, 1995.
  50. Briggs NC, Young TB, Gilchrist KW, et al.: Age as a predictor of an aggressive clinical course for superficial bladder cancer in men. Cancer 69 (6): 1445-51, 1992.
  51. Lynch CF, Platz CE, Jones MP, et al.: Cancer registry problems in classifying invasive bladder cancer. J Natl Cancer Inst 83 (6): 429-33, 1991.
  52. Saxman SB, Propert KJ, Einhorn LH, et al.: Long-term follow-up of a phase III intergroup study of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 15 (7): 2564-9, 1997.
  53. Jewett HJ, Strong GH: Infiltrating carcinoma of the bladder: relation of depth of penetration of the bladder wall to incidence of local extension and metastases. J Urol 55: 366-372, 1946.
  54. Kaye KW, Lange PH: Mode of presentation of invasive bladder cancer: reassessment of the problem. J Urol 128 (1): 31-3, 1982.
  55. Hopkins SC, Ford KS, Soloway MS: Invasive bladder cancer: support for screening. J Urol 130 (1): 61-4, 1983.
  56. Holmäng S, Hedelin H, Anderström C, et al.: The relationship among multiple recurrences, progression and prognosis of patients with stages Ta and T1 transitional cell cancer of the bladder followed for at least 20 years. J Urol 153 (6): 1823-6; discussion 1826-7, 1995.
  57. Prout GR Jr, Barton BA, Griffin PP, et al.: Treated history of noninvasive grade 1 transitional cell carcinoma. The National Bladder Cancer Group. J Urol 148 (5): 1413-9, 1992.
  58. Messing EM, Young TB, Hunt VB, et al.: Hematuria home screening: repeat testing results. J Urol 154 (1): 57-61, 1995.
  59. Whelan P, Britton JP, Dowell AC: Three-year follow-up of bladder tumours found on screening. Br J Urol 72 (6): 893-6, 1993.
  60. Mohr DN, Offord KP, Owen RA, et al.: Asymptomatic microhematuria and urologic disease. A population-based study. JAMA 256 (2): 224-9, 1986.
  61. Hiatt RA, Ordoñez JD: Dipstick urinalysis screening, asymptomatic microhematuria, and subsequent urological cancers in a population-based sample. Cancer Epidemiol Biomarkers Prev 3 (5): 439-43, 1994 Jul-Aug.
  62. Friedman GD, Carroll PR, Cattolica EV, et al.: Can hematuria be a predictor as well as a symptom or sign of bladder cancer? Cancer Epidemiol Biomarkers Prev 5 (12): 993-6, 1996.
  63. Messing EM, Young TB, Hunt VB, et al.: The significance of asymptomatic microhematuria in men 50 or more years old: findings of a home screening study using urinary dipsticks. J Urol 137 (5): 919-22, 1987.
  64. Kiemeney LA, Coebergh JW, Koper NP, et al.: Bladder cancer incidence and survival in the south-eastern part of The Netherlands, 1975-1989. Eur J Cancer 30A (8): 1134-7, 1994.
  65. Rife CC, Farrow GM, Utz DC: Urine cytology of transitional cell neoplasms. Urol Clin North Am 6 (3): 599-612, 1979.
  66. Murphy WM, Rivera-Ramirez I, Medina CA, et al.: The bladder tumor antigen (BTA) test compared to voided urine cytology in the detection of bladder neoplasms. J Urol 158 (6): 2102-6, 1997.
  67. Yamaguchi N, Tazaki H, Okubo T, et al.: Periodic urine cytology surveillance of bladder tumor incidence in dyestuff workers. Am J Ind Med 3 (2): 139-48, 1982.
  68. Cartwright RA: Bladder cancer screening in the United Kingdom. J Occup Med 32 (9): 878-80, 1990.
  69. Schulte PA: Screening for bladder cancer in high-risk groups: delineation of the problem. J Occup Med 32 (9): 789-92, 1990.
  70. Cartwright RA, Gadian T, Garland JB, et al.: The influence of malignant cell cytology screening on the survival of industrial bladder cancer cases. J Epidemiol Community Health 35 (1): 35-8, 1981.
  71. Thériault GP, Tremblay CG, Armstrong BG: Bladder cancer screening among primary aluminum production workers in Quebec. J Occup Med 32 (9): 869-72, 1990.
  72. 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 93 (6): 427-36, 2001.
1|2|3|4|5|6
1|2|3|4|5|6

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Next Article:

Today on WebMD

Integrative Medicine Cancer Quiz
QUIZ
what is your cancer risk
HEALTH CHECK
 
cancer fighting foods
SLIDESHOW
Bladder Cancer Why More Men May Be At Risk
VIDEO
 
Lifestyle Tips for Depression Slideshow
SLIDESHOW
Bladder Sparing Cancer Treatment
VIDEO
 
Vitamin D
SLIDESHOW
Pets Improve Your Health
SLIDESHOW
 

WebMD Special Sections