Abstract | BACKGROUND: To determine whether high-risk patients with hematuria receive evaluation according to guideline recommendations. METHODS: We recently performed a screening study for bladder cancer using a urine-based tumor marker in 1502 subjects at high risk based on aged > or = 50 years, > or = 10-year smoking history, and/or a 15-year or more environmental exposure. We evaluated use of urinalysis (UA) within 3 years preceding the screening study. Chart review was performed to determine if this subset with microhematuria received any additional evaluation. RESULTS: Of 1502 study participants, routine urinalysis was performed in 73.2% and 164 (14.9%) subjects had documented hematuria (>3 red blood cells / high-power field) before inclusion. Of these, 42.1% had no further evaluation. Additional testing included repeat urinalysis (36%), urine culture (15.2%), cytology (10.4%), imaging (22.6% overall: 15.9% computed tomography, 4.3% intravenous pyelography; 2.4% magnetic resonance imaging), and cystoscopy (12.8%). Three subjects with microscopic hematuria (2%) were subsequently found to have bladder cancer during the screening study but were not referred for evaluation based on their hematuria. The source of hematuria was unknown in 65%, infection in 22%, benign prostatic enlargement in 10%, and renal stone disease in 4%, but these results are based on incomplete evaluation since only 12.8% underwent cystoscopy. CONCLUSIONS: Subjects at high risk for bladder cancer based on > or = 10 years of smoking or environmental exposure with microscopic hematuria are rarely evaluated thoroughly and only 12.8% were referred for urologic evaluation. Further studies are needed to evaluate both the utilization and effectiveness of guidelines for hematuria.
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Authors | Keren Elias, Robert S Svatek, Samir Gupta, Richard Ho, Yair Lotan |
Journal | Cancer
(Cancer)
Vol. 116
Issue 12
Pg. 2954-9
(Jun 15 2010)
ISSN: 0008-543X [Print] United States |
PMID | 20564400
(Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)
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Chemical References |
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Topics |
- Biomarkers, Tumor
(analysis)
- Cytological Techniques
(statistics & numerical data)
- Diagnostic Imaging
(statistics & numerical data)
- Female
- Hematuria
(diagnosis, etiology)
- Humans
- Male
- Middle Aged
- Occupational Exposure
- Practice Guidelines as Topic
- Referral and Consultation
- Risk
- Smoking
- Time Factors
- Urinalysis
(statistics & numerical data)
- Urinary Bladder Neoplasms
(diagnosis)
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