Can hematuria be a predictor as well as a symptom or sign of bladder cancer?
In a case-control study of urinalysis screening in the prevention of death from bladder cancer, hematuria was present in a higher proportion of cases than controls as long as five or six years before the diagnostic evaluation that led to the diagnosis of bladder cancer. In a separate cohort study data base that permitted the follow-up of 1046 persons with a physician's diagnosis of hematuria, 11 cases of bladder cancer were diagnosed more than two (mean 7.4) years after the hematuria diagnosis (4.3 cases expected; age-sex standardized morbidity ratio, 2.5; 95% confidence interval, 1.3-4.5). Bladder cancer was ruled out initially by cystoscopy in 8 of the 11 cases. Although we cannot be certain that preexisting bladder cancer or bladder cancer risk factors did not cause the bleeding, we hypothesize that hematuria can be a predictor as well as a manifestation of bladder cancer, based on a tendency for bladder mucosa with premalignant changes to bleed. The implications for screening and clinical practice remain to be determined.
Friedman
G D
GD
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94611, USA.
Carroll
P R
PR
Cattolica
E V
EV
Hiatt
R A
RA
D000368:Aged; D002140:California / Q000453:epidemiology; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D003558:Cystoscopy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology