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Screening Adults for Bladder Cancer

Table 1. Screening Studies

Study, Year (Reference) Population Study Design Screening Test Sample Size Results Quality Score
Friedman et al, 1995 (21) Case patients: fatal bladder cancer among Kaiser Permanente subscribers

Control participants: living; a member of Kaiser Permanente; matched on age, sex, and date of joining program

Case-control study Urinalysis 290 case patients and 290 control participants Bladder cancer death vs. living matched control participants:

Screening urinalysis within the 5 y before symptoms or findings leading to the cancer diagnosis (adjusted for smoking and occupational bladder cancer risk): OR, 0.60 (95% CI, 0.41-0.87)

Any urinalysis within the 5 y before symptoms or findings leading to the cancer diagnosis (adjusted for smoking and occupational bladder cancer risk): OR, 0.94 (CI, 0.61-1.46)

Poor; unable to accurately ascertain reason for urinalyses or presence of symptoms
Messing et al, 1995 (20) and 2006 (22) Asymptomatic men aged >50 y from primary care settings (screening population) and bladder cancer cases reported to a statewide registry in the United States Prospective cohort of screened persons compared with cases reported to a statewide registry Periodic home urinalysis for hematuria 1575 in screening cohort (1940 declined to participate); 511 cases reported to cancer registry Rate of positive screenings: 16% (258 of 1574)

Positive predictive value: 8% (21 of 258)

Screened patients vs. registry cases:
Low-grade superficial bladder cancer at diagnosis: 52% (11 of 21) vs. 57% (290 of 511); RR, 0.92 (CI, 0.61-1.4)

High-grade superficial bladder cancer at diagnosis: 43% (9 of 21) vs. 19% (99 of 511); RR, 2.2 (CI, 1.3-3.7)

Muscle-invasive or higher-stage bladder cancer at diagnosis: 4.8% (1 of 21) vs. 24% (122 of 511); RR, 0.20 (CI, 0.03-1.4)

Bladder cancer death at 14 y: 0% (0 of 21) vs. 20% (104 of 509); P = 0.01

Overall mortality at 14 y: 43% (9 of 21) vs. 54% (273 of 509); RR, 0.80 (CI, 0.48-1.32)

Screened patients vs. unscreened patients:
Bladder cancer diagnosis: 1.3% (21 of 1574) vs. 1.2% (23 of 1940)
Poor; no inception cohort of similar unscreened persons and no adjustment for potential confounders
Thériault et al, 1990 (23) Aluminum workers with >5-10 y exposure to tar volatiles who received a diagnosis of bladder cancer during the screening program (1980-1986) vs. before the screening program (1970-1979) in Quebec Retrospective cohort study with historical control Annual urine cytology 79 (30 screened and 49 not screened) Screened patients vs. unscreened patients:
Early-stage bladder cancer: 77% (23 of 30) vs. 67% (33 of 49); P > 0.10

Mortality (age-adjusted): RR, 0.54 (CI, 0.20-1.48)
Poor; historical cohort and no adjustment for potential confounders

OR = odds ratio; RR = relative risk.

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