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Screening for Bladder Cancer: Recommendations from the U.S. Preventive Services Task Force FREE

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The full report is titled “Screening for Bladder Cancer: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 16 August 2011 issue of Annals of Internal Medicine (volume 155, pages 246-251). The author is the U.S. Preventive Services Task Force.

Ann Intern Med. 2011;155(4):I-36. doi:10.7326/0003-4819-155-4-201108160-00002
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

In the United States, bladder cancer is the fourth and ninth most commonly diagnosed cancer in men and women, respectively. In 2009, about 70,000 new cases of bladder cancer were diagnosed in the United States and about 14,000 persons died of the disease. Symptoms of bladder cancer include bloody urine, a frequent urge to urinate, painful urination, and low back pain, symptoms that are also common with other conditions. Risk factors for bladder cancer include smoking; family history of bladder cancer; and working in the chemical, rubber, or leather industries. Screening tests that might find bladder cancer before symptoms develop include urine tests to look for blood, cancer cells, or tumor biomarkers.

Treatments for bladder cancer include surgery, radiation, chemotherapy, and biologic therapy. Biologic therapy boosts your body's own ability to fight cancer. Bladder cancer can be superficial or invasive. Most cases present as superficial tumors of the bladder lining, but invasive tumors go through the layers of the bladder and spread (metastasize) to other parts of the body. Patients with invasive bladder cancer do not do well. Superficial bladder cancer is easier to treat but often comes back after treatment.

How did the USPSTF develop these recommendations?

The USPSTF updated its previous 2004 recommendation by reviewing relevant research, published up to December 2009, about the potential benefits and harms of screening for bladder cancer.

What did the authors find?

The USPSTF found no evidence that addressed the accuracy of screening tests in adults without symptoms. The group noted that most persons with positive screening results do not have bladder cancer and that the harms of false-positive results are unclear. The USPSTF found no high-quality studies that evaluated clinical outcomes associated with screening compared with no screening.

What does the USPSTF recommend that patients and doctors do?

The USPSTF concluded that current evidence was insufficient to assess the balance of benefits and harms of screening for bladder cancer. The group therefore made no recommendation to screen or not to screen. If screening is done, the most easily available tests are urine tests to look for blood or cancer cells. Biomarker tests are expensive. Adults with a positive screening result are usually sent to a urologist for further testing.

What are the cautions related to these recommendations?

These guidance statements apply to persons without symptoms who have average risk for bladder cancer.





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