title: Select screening in a specific high-risk population of patients suggests a stage migration toward detection of non-muscle-invasive bladder cancer.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  We evaluated whether a BC screening protocol in a high-risk and unique patient population had an impact on the stage of tumor presentation.
  
  
  METHODS
  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.
  
  
  METHODS
  Patients were evaluated for presence of BC and tumor stage at diagnosis.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Urology, Mount Sinai Hospital, Toronto, Canada. azlotta@mtsinai.on.ca
authors: Alexandre R
authors: AR
authors: Zlotta
authors: Thierry
authors: T
authors: Roumeguere
authors: Cynthia
authors: C
authors: Kuk
authors: Sultan
authors: S
authors: Alkhateeb
authors: Sandrine
authors: S
authors: Rorive
authors: Anne
authors: A
authors: Lemy
authors: Theodorus H
authors: TH
authors: van der Kwast
authors: Neil E
authors: NE
authors: Fleshner
authors: Michael A S
authors: MA
authors: Jewett
authors: Antonio
authors: A
authors: Finelli
authors: Claude
authors: C
authors: Schulman
authors: Yair
authors: Y
authors: Lotan
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Joelle
authors: J
authors: Nortier
mesh_terms: D019440:Anti-Obesity Agents / Q000009:adverse effects*; D034341:Aristolochic Acids / Q000009:adverse effects*; D001284:Atrophy; D001706:Biopsy; D003558:Cystoscopy; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D055088:Early Detection of Cancer; D005260:Female; D005355:Fibrosis; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology
chemical_list: D019440:Anti-Obesity Agents; D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal