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Long-term outcome of hematuria home screening for bladder cancer in men

  1. Edward M. Messing MD1,†,*,
  2. Ralph Madeb MD1,
  3. Terry Young PhD2,
  4. Kennedy W. Gilchrist MD3,
  5. Lora Bram MS4,
  6. E. Barry Greenberg MD4,
  7. John D. Wegenke MD4,
  8. Laura Stephenson BS5,
  9. Jason Gee MD4,
  10. Changyong Feng PhD6

Article first published online: 6 OCT 2006

DOI: 10.1002/cncr.22224

Issue

Cancer

Cancer

Volume 107, Issue 9, pages 2173–2179, 1 November 2006

Additional Information

How to Cite

Messing, E. M., Madeb, R., Young, T., Gilchrist, K. W., Bram, L., Greenberg, E. B., Wegenke, J. D., Stephenson, L., Gee, J. and Feng, C. (2006), Long-term outcome of hematuria home screening for bladder cancer in men. Cancer, 107: 2173–2179. doi: 10.1002/cncr.22224

Author Information

  1. 1

    Department of Urology, University of Rochester, Rochester, New York

  2. 2

    Department of Preventative Medicine, University of Wisconsin at Madison, Madison, Wisconsin

  3. 3

    Department of Pathology, University of Wisconsin at Madison, Madison, Wisconsin

  4. 4

    Department of Surgery, University of Wisconsin at Madison, Madison, Wisconsin

  5. 5

    Wisconsin Cancer Reporting System, Madison, Wisconsin

  6. 6

    Department of Biostatistics, University of Rochester, Rochester, New York

  1. †

    Fax: (585) 442-8350

*Department of Urology, University of Rochester, 601 Elmwood Avenue, Box 656, Rochester, NY 14642

Publication History

  1. Issue published online: 24 OCT 2006
  2. Article first published online: 6 OCT 2006
  3. Manuscript Accepted: 28 JUL 2006
  4. Manuscript Revised: 25 JUL 2006
  5. Manuscript Received: 15 JUN 2006

Funded by

  • State of Wisconsin Division of Health
  • Department of Health and Social Services
  • Ashley Family Foundation

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Keywords:

  • bladder cancer;
  • screening;
  • hematuria;
  • bladder cancer mortality;
  • high-grade cancers

Repetitive home screening for hematuria in healthy men aged ≥50 years with chemical reagent strips reduced bladder cancer and overall mortality significantly during 14 years of follow-up compared with outcomes in a prospective, comparable, unscreened population with bladder cancer. Reduced bladder cancer mortality occurred because screening permitted the diagnosis of high-grade cancers at preinvasive stages far more frequently than standard clinical presentation.

Abstract

BACKGROUND.

The objectives of this study were to determine whether bladder cancer (BC) screening in healthy men could lead to earlier detection and reduced BC mortality compared with unscreened men and to determine long-term outcomes of a geographically defined, unscreened population with newly diagnosed BC.

METHODS.

In 1987 and from 1998 to 1992, 1575 men ages 50 years and older who were solicited from well patient rosters in clinics in and around Madison, Wisconsin, tested their urine repetitively with a chemical reagent strip for hemoglobin. Participants who had positive test results underwent standard urologic evaluation. BC grades and stages and the outcomes of men with BC detected by screening were compared with the grades, stages, and outcomes of 87% of men ages 50 years and older with newly diagnosed BC who were reported to the Wisconsin Tumor Registry in 1988 (n = 509 men).

RESULTS.

Two hundred fifty-eight screening participants (16.4%) were evaluated for hematuria, and 21 participants (8.1%) were diagnosed with BC. Proportions of low-grade (Grade 1 and 2) superficial (Stage Ta and T1) versus high-grade (Grade 3) superficial or invasive (Stage ≥ T2) cancers in screened men (52.4% vs. 47.7%) and in men from the tumor registry (60.3% vs. 39.7%) were similar (P = .50). The proportion of high-grade superficial or invasive BCs that were invasive were lower in screened men (10%) than in unscreened men (60%; P = .002). At 14 years of follow-up, no men with screen-detected BC had died of BC, whereas 20.4% of men with unscreened BC had died of BC (P = .02).

CONCLUSIONS.

Screening effected the early detection of BC and may reduce mortality from BC compared with BC that is diagnosed at standard clinical presentation. Cancer 2006. © 2006 American Cancer Society.

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