Screening for Bladder Cancer: A Systematic Review

Objectives: We performed a systematic review of the literature to evaluate the potential benefits and harms of a screening program for bladder cancer in a targeted, primary care population of men over age 50. We sought to answer five Key Questions deemed necessary to make a recommendation for or against screening: 1) Does screening for bladder cancer lead to decreased morbidity or mortality?, 2) Do potential screening modalities have appropriate test characteristics to warrant their use as a screening test?, 3) Does earlier treatment of early stage reduce morbidity and mortality more than later treatment?, 4) What are the harms of screening?, and 5) What are the harms of a full urologic workup? Methods: For each Key Question, we searched MEDLINE, EMBASE, and the Cochrane database of reviews and trials for studies published in English between 1982 and 2010. Data was extracted from articles that met our eligibility criteria by two independent observers. Study quality was assessed using criteria adapted from the US Preventive Services Task Force, and results were synthesized qualitatively. Results: Two studies were identified that performed a trial of screening and reported long-term mortality results. A mortality benefit of screening was found in one study, but both were poorly designed and definitive conclusions cannot be drawn. Eleven studies of diagnostic accuracy for potential screening tests were identified that met our eligibility criteria. None of the six examined tests (hemoglobin dipstick, urine cytology, NMP22, BTA stat, ImmunoCyt and Urovysion FISH) were found to have an adequate combination of sensitivity and specificity for use as a screening test, and overall study quality was poor. We found no studies examining the effects of earlier treatment versus later treatment of early stage bladder cancer, and no studies examining the harms of screening. Harms identified for a urologic workup include urinary tract infection and sexual dysfunction from cystoscopy, and heavy doses of radiation from imaging studies. Conclusions: The available evidence is not sufficient to recommend screening for bladder cancer in a primary care population. There is a need for a widespread, randomized controlled trial examining both the benefits and harms of a potential screening program.Master of Public Healt