Virginia A. Moyer, MD, MPH; on behalf of the U.S. Preventive Services Task Force
This article has been corrected. For original version, click "Original Version (PDF)" in column 2.
Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for bladder cancer.
The USPSTF performed a targeted literature search for new evidence on the benefits and harms of screening, the accuracy of primary care–feasible screening tests, and the benefits and harms of treatment.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for bladder cancer in asymptomatic adults (I statement).
For a summary of the evidence systemically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to www.uspreventiveservicestaskforce.org/.
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Christopher C.K. Ho
Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre
August 31, 2011
Screening for Bladder Cancer: U.S. Preventive Services Task Force Recommendation Statement
TO THE EDITOR:
I read with interest the article by the U.S . Preventive Services Task Force (USPSTF) recommendation on screening for bladder cancer (1). In this article, the USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for bladder cancer in asymptomatic adults. This is not encouraging for the following reasons.
About 70-75% of bladder cancers are non-muscle invasive (Ta/T1) while 25-30% are muscle invasive (T2 and higher) at presentation. Out of this, 20-40% of the non-muscle invasive bladder cancers progress to muscle invasion. The 10-year disease-free survival of muscle-invasive disease is 50-60% (2). Therefore, early detection is extremely important to improve the prognosis of bladder cancer. Messing et al. has also shown that screened group has better survival than that among individuals diagnosed with symptomatic bladder cancer (3).
Furthermore, bladder cancer has a fairly short potential lead time. In other words, the interval between diagnosing it because of screening and diagnosing when it is symptomatic is very brief. Therefore, it can be argued that patients in whom bladder cancer is detected through screening would not undergo any unnecessary tests or treatments, only earlier ones (4).
Khochikar (5) very aptly stated that early detection and screening of bladder cancer is needed as delay in the diagnosis and treatment does alter the overall outcome. Indeed, there is a role of screening for bladder cancers especially those in the high-risk group. We should not deprive our patients of the rights to be screened since the incidence of bladder cancer is increasing globally.
This should be a challenge to researchers to carry out more robust studies as concrete recommendation is needed to address this issue.
1.Moyer VA; on behalf of the U.S. Preventive Services Task Force. Screening for Bladder Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2011;155(4):246-251.
2.Thalmann GN, Stein JP. Outcomes of radical cystectomy. BJU Int. 2008;102:1279-88
3.Messing EM, Madeb R, Young T, Gilchrist KW, Bram L, Greenberg EB, et al. Long term outcome of hematuria home screening for bladder cancer in men. Cancer. 2006;107:2173-9.
4.Goldstein MM, Messing EM. Prostate and Bladder Cancer Screening. J Am Coll Surg. 1998;186(1): 63-74.
5.Khochikar MV. Rationale for an early detection program for bladder cancer. Indian J Urol. 2011;27(2):218-25.
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for Bladder Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. ;155:246–251. doi: 10.7326/0003-4819-155-4-201108160-00008
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Published: Ann Intern Med. 2011;155(4):246-251.
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