Division of Urology, Mount Sinai Hospital, Toronto, Canada.
Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada.
More than 25% of bladder cancer (BC) cases are still muscle-invasive at first diagnosis. Screening is unproven to enable the detection of more non-muscle-invasive tumors. BC association with aristolochic acid nephropathy (AAN) was reported after intake of slimming pills containing Chinese herbs.
We evaluated whether a BC screening protocol in a high-risk and unique patient population had an impact on the stage of tumor presentation.
Forty-eight AAN-affected patients were enrolled in a screening program, establishing BC incidence during prospective screening cystoscopies and biopsies biannually for up to 10 yr. Two patients were lost to follow-up, and three refused screening after consenting.
Patients were evaluated for presence of BC and tumor stage at diagnosis.
BC was diagnosed in 25 patients (52%). Among 43 patients who underwent screening cystoscopies (median follow-up: 94 mo), 22 were first diagnosed with non-muscle-invasive BC but none with muscle-invasive tumors and none died of BC. Three women who declined follow-up were diagnosed and died with advanced metastatic disease. The limitations of our findings include the small sample size of this case series, the absence of a real control group, and the particular risk factor in these patients that differs from the usual risk factors, such as smoking or industrial chemicals.
BC screening in high-risk groups may allow identification of tumors before muscle invasion. The optimal screening schedule and the relevance of the present findings in smoking-related BC remain to be defined.
Written by:
Zlotta AR, Roumeguere T, Kuk C, Alkhateeb S, Rorive S, Lemy A, van der Kwast TH, Fleshner NE, Jewett MA, Finelli A, Schulman C, Lotan Y, Shariat SF, Nortier J. Are you the author?
Reference: Eur Urol. 2011 Mar 30. Epub ahead of print.
doi: 10.1016/j.eururo.2011.03.027
PubMed Abstract
PMID: 21458152
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