Long-term outcome of hematuria home screening for bladder cancer in men.
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 > or = 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.
Messing
Edward M
EM
Department of Urology, University of Rochester, Rochester, New York 14642, USA. edward_messing@urmc.rochester.edu
Madeb
Ralph
R
Young
Terry
T
Gilchrist
Kennedy W
KW
Bram
Lora
L
Greenberg
E Barry
EB
Wegenke
John D
JD
Stephenson
Laura
L
Gee
Jason
J
Feng
Changyong
C
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003710:Demography; D005500:Follow-Up Studies; D006417:Hematuria / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D013995:Time; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology