Screening for Bladder Cancer?

Blood in the urine, called hematuria, is one of the signs of bladder cancer. But there are other causes for hematuria – a kidney stone, a non-malignant bladder tumor, a bladder infection . . . and in women, menstruation; so that in fact, only one in ten cases of blood in the urine is due to a malignant bladder cancer. However, that doesn’t mean that screening for hematuria isn’t worthwhile.

Researchers at Rochester, NY, randomly screened the urine of over 1500 men in their 50s attending well-patient clinics between 1987 and 1992. The men tested their urine daily for 14 days using a dipstick (Ames Hemastix ®) at enrollment, and again 9 months later. Over 250 men (about 16.5%) had microscopic traces of blood in their urine, and were followed up by urologists. Out of these, 21 (8%) were found to have bladder cancer and were treated.

One batch of men in the test were compared with a non-screened group; the same proportion of men in each group had low-grade bladder cancer – about half. Both groups were assessed again 14 years later. There were 20% deaths in the unscreened group due to bladder cancer, compared with none in the screened group.

It seems clear that screening for bladder cancer is easy and cheap – though the urologist’s follow-up of positive tests is expensive, of course. It remains to be seen if health insurance companies will cover it.