Medical follow-up for workers exposed to bladder carcinogens: the French evidence-based and pragmatic statement.
BACKGROUND
The aim of this work was to establish recommendations for the medical follow-up of workers currently or previously exposed to carcinogenic substances for the bladder.


METHODS
A critical synthesis of the literature was conducted. Sectors of activity where workers are or were exposed to carcinogenic substances for the bladder were listed and classified according to the level of bladder cancer risk. Performances of techniques available for the targeted screening of bladder cancer were analysed, including a simulation of results among high-risk populations in France.


RESULTS
The risk level for the professional group and the latency period between the start of exposure and the natural history of the disease were selected to define a targeted screening protocol. The NMP22BC test, exclusive haematuria testing, and combinations of urine cytology with, respectively, the NMP22BC test and haematuria test, generated an extremely high proportion of false positive results.


CONCLUSIONS
Urine cytology is the test that offers the best specificity. Although poor for all bladder cancer stages and grades combined, its sensitivity is better for high grades, which require early diagnosis since late-stage cancers are of very poor prognosis. These results suggest that urine cytology is currently the only technique suitable for proposal within the context of a first line targeted screening strategy for occupational bladder cancer. An algorithm summarising the recommended medical follow-up for workers currently or previously exposed to carcinogenic substances for the bladder is proposed, based on the level of risk of bladder cancer.
Cancers and prevention, U1086 INSERM, Faculty of Medicine, Caen University Hospital, Caen, France. clin-b@chu-caen.fr.
Bénédicte
B
Clin
Jean-Claude
JC
Pairon
D002273:Carcinogens / Q000633:toxicity*; D055088:Early Detection of Cancer; D005500:Follow-Up Studies; D005602:France; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008403:Mass Screening; D009784:Occupational Diseases / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D011379:Prognosis; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D014556:Urine / Q000166:cytology
D002273:Carcinogens