Screening for Bladder Cancer in Adults: Recommendation Statement: United States Preventive Services Task Force
Abstract
This statement summarizes the U.S. Preventive Services Task Force recommendations on screening for bladder cancer in adults and the supporting scientific evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, Second Edition.1 In 1996, the Task Force recommended against screening for bladder cancer with microscopic urinalysis, urine dipstick, or urine cytology in asymptomatic persons (a "D" recommendation).1 Since then, the Task Force criteria to rate the strength of the evidence have changed. 2 Therefore, this recommendation statement has been updated and revised based on the current Task Force methodology and rating of the strength of the evidence. Explanations of the current Task Force ratings and of the strength of overall evidence are given in Appendix A and Appendix B, respectively. The complete information on which this statement is based, including evidence tables and references, is contained in the brief update "Screening for Bladder Cancer,"3 available through the U.S. Preventive Services Task Force Web site (http://www.preventiveservices.ahrq.gov). The recommendation statement and brief update are also available in print from the Agency for Healthcare Research and Quality Publications Clearinghouse (call 1-800-358-9295, or e-mail ahrqpubs@ahrq.gov). The recommendation is also posted on the Web site of the National Guideline Clearinghouse™ (http://www.guideline.gov).
Agency for Healthcare Research and Quality
US Department of Health and Human Services
Recommendations made by the U.S. Preventive Services Task Force are independent of the U.S. Government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Summary of the Recommendation
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for bladder cancer in adults. D recommendation.
The USPSTF found fair evidence that screening with available tests can detect bladder cancer in asymptomatic individuals. The potential benefit of screening would be small, at best, for the following reasons: there is fair evidence that many of the cancers detected by screening have a low tendency to progress to invasive disease; there is a relatively low overall prevalence of asymptomatic bladder cancer that would eventually lead to important clinical consequences; and there is limited evidence that early treatment of bladder cancer detected through screening improves long-term health outcomes. The potential harms of screening are at least small: screening tests have a low positive predictive value and yield many false positive results, leading to unnecessary invasive procedures. As a result, the USPSTF concluded that the potential harms of screening for bladder cancer outweigh any potential benefits.
Clinical Considerations
-
Bladder cancer is 2 to 3 times more common in men than in women and is unusual before age 50. Bladder cancer is heterogeneous; it is a spectrum of conditions, most of which are not life-threatening.
-
Screening tests--such as microscopic urinalysis, urine dipstick, urine cytology, or such new tests as bladder tumor antigen (BTA) or nuclear matrix protein (NMP22) immunoassay--can detect bladder cancers that are clinically unapparent. However, because of the low prevalence of bladder cancer, the positive predictive value of these tests is low.
-
Smoking increases the risk for bladder cancer; about 50% of all cases of bladder cancer occur in current or former smokers. Smokers should be counseled on quitting smoking.
-
People in occupations that involve exposure to chemicals used in the dye or rubber industries may also have increased risk for bladder cancer. The USPSTF did not review the evidence for targeted screening for those with occupational exposure.
Corresponding author: Ned Calonge, MD, MPH, Chair, U.S. Preventive Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, e-mail: uspstf@ahrq.gov.
Members of the U.S. Preventive Services Task Force* are Alfred O. Berg, MD, MPH, Chair (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, PhD, RN, CS, Vice-chair (Dean, School of Nursing, University of Maryland Baltimore, Baltimore, MD); Ned Calonge, MD, MPH (Acting Chief Medical Officer, Colorado Department of Public Health and Environment, Denver, CO); Paul Frame, MD (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Joxel Garcia, MD, MBA (Deputy Director, Pan American Health Organization, Washington, DC); Russell Harris, MD, MPH (Associate Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); Mark S. Johnson, MD, MPH (Professor of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, MD, MPH (Associate Professor, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY); Carol Loveland-Cherry, PhD, RN (Executive Associate Dean, School of Nursing, University of Michigan, Ann Arbor, MI); Virginia A. Moyer, MD, MPH (Professor, Department of Pediatrics, University of Texas at Houston, Houston, TX); C. Tracy Orleans, PhD (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Albert L. Siu, MD, MSPH (Professor and Chairman, Brookdale Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, NY); Steven M. Teutsch, MD, MPH (Executive Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, MD, MSc (Professor of Obstetrics and Gynecology and Professor of Public Health, Columbia University, New York, NY); and Steven H. Woolf, MD, MPH (Professor, Department of Family Practice and Department of Preventive and Community Medicine and Director of Research, Department of Family Practice, Virginia Commonwealth University, Fairfax, VA).
*Members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
Find more information about
Agency for Healthcare Research and Quality http://www.ahrq.gov/
Appendix A
U.S. Preventive Services Task Force Recommendations And Ratings
The Task Force grades its recommendations according to one of 5 classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms):
A. The U.S. Preventive Services Task Force strongly recommends that clinicians provide [the service] to eligible patients. The U.S. Preventive Services Task Force found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B. The U.S. Preventive Services Task Force recommends that clinicians provide [the service] to eligible patients. The U.S. Preventive Services Task Force found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C. The U.S. Preventive Services Task Force makes no recommendation for or against routine provision of [the service]. The U.S. Preventive Services Task Force found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D. The U.S. Preventive Services Task Force recommends against routinely providing [the service] to asymptomatic patients. The U.S. Preventive Services Task Force found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I. The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that [the service] is effective is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Appendix B
U.S. Preventive Services Task Force Strength Of Overall Evidence
The U.S. Preventive Services Task Force grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor):
Good: Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes.
Fair: Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes.
Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.