ANAHEIM, CA (UroToday.com) - Dr. Bart Grossman presented a State-of-the-Art lecture "Is Screening for Bladder Cancer Ready for Prime Time?" at the Tuesday Plenary Session of the AUA in Anaheim, May 22, 2007.

Dr. Grossman showed that some bladder cancer (TCC) screening programs are already taking root. This included a program for the San Francisco Fire Department members. However, he cautioned that we should not fall into the pitfalls of prostate cancer screening. Screening, he pointed out does not include those with microhematuria as these people had signs warranting an evaluation. Screening is looking for a disease in those with no signs or symptoms. TCC is the fourth most common cause of cancer in the US and eighth most common cause of cancer death. The lifetime cost of treating TCC is over $100,000. Thus if it is important to detect it, can we do so? Cystoscopy remains the gold standard and the addition of fluorescence can improve detection and treatment results in lower recurrence rates over 3 years.

Screening should be applied to risk groups, not just the general public. Smoking and exposure to carcinogens would be possibly appropriate. Smokers have a much higher incidence of TCC and it correlates to the number of pack-years smoked. Those with >40 pack years are at highest risk. He then addressed whether detection improves outcome. Dr. Messing (Cancer, 2006) showed that TCC detected by screening did not benefit if they had low grade, non-invasive disease. Yet, for invasive disease there were improved outcomes and decreased death from TCC. Analysis by Dr. Grossman showed that of 1,575 participants, 258 were eventually evaluated and only 21 patients had TCC detected, for a low yield. The cost effectiveness needs to be determined. He cited a paper by Dr. Lotan, who developed a Markov model that suggested a cost saving of $101,00 would be made by screening. This needs to be validated in a patient population.

In conclusion, TCC is worth detecting and the ability to treat it is good. Whether it is cost effective needs to be determined. Challenges to screening include the long lag time between exposure and clinical disease, defining a suitable population, defining appropriate markers and defining the significance of a positive molecular test and a negative cystoscopy. At present it is not ready for prime time and need further validation in clinical trails.

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Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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