AUA 2020: Global Variation in Cancer Detection Rates in Patients referred to Secondary Care with Haematuria: Do Some Over-Investigate? Results from the IDENTIFY Collaborative Study

( Haematuria is among the most common presentations from primary care to the urology clinic. The underlying rate of malignancy varies according to the severity of haematuria and tumor site. There is significant variation in the evaluation of patients with haematuria between countries, particularly with respect to imaging of the upper tract. In a moderated poster presentation at the American Urologic Association (AUA) 2020 Virtual Annual Meeting, Kevin Gallagher and colleagues assessed the prevalence of urinary tract cancer (UTC) among patients seen for haematuria in secondary care. Secondary aims were to explore reasons for differences in prevalence between countries.

To do so, the authors utilized data from IDENTIFY — The Investigation and DEtection of urological Neoplasia in paTIents reFerred with suspected urinary tract cancer: A multicentre analYsis — a prospective international cohort study. Patients referred to secondary care with symptoms of urinary tract cancer (no previous history of UTC) were included. Data on presenting symptoms, investigations, and diagnoses were recorded in an online database.

The authors examined data on 10873 patients from 110 hospitals in 25 countries. 7155 patients (65.5%) had visible or gross haematuria while 3155 had (28.9%) had non-visible or microscopic haematuria and 614 (5.6%) were referred for a reason other than haematuria. 

The rate of urinary tract cancer detected in secondary care varied between countries from 4.8% to 72% (median 26%, IQR 11.9-42.0). 


Using a mixed model with age, haematuria type, gender, smoking status, and imaging protocol as fixed effects and country and hospital as random effects the adjusted prevalence of urinary tract cancer in this population was 26.2% (95% CI 18.6-35.5). 

Country was associated with cancer detection rate independent of age, the type of haematuria investigated, gender and smoking (p<0.001). Countries with a higher “healthcare access and quality index” had significantly lower cancer detection rates (r=0.51 p=0.008). 

At a national level, the proportion of patients with visible or gross haematuria, the mean age of patients referred, and the proportion of patients who smoked were all associated with an increased likelihood of cancer detection.

Interestingly, the incidence of bladder cancer in the population of each country in 2018 using the international Globocan registry did not significantly correlate with the bladder cancer detection rate in the IDENTIFY study cohort from that country (r=0.24, p=0.25).

Presented by: Arighno Das, MD, University of Wisconsin School of Medicine and Public Health, Barrington, IL, USA

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Nashville, TN, USA, Twitter: @WallisCJD, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020

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