Screening Adults for Bladder Cancer: A Review of the Evidence for the U.S. Preventive Services Task Force

Background: Bladder cancer is 1 of the 10 most frequently diagnosed types of cancer. Screening could identify high-grade bladder cancer at earlier stages, when it may be more easily and effectively treated. Purpose: To update the 2004 U.S. Preventive Services Task Force evidence review on screening for bladder cancer in adults in primary care settings. Data Sources: MEDLINE (2002 to December 2009), the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials (through the fourth quarter of 2009), and the CancerLit subsection of PubMed (through March 2010) were searched for studies published in English. Study Selection: Randomized trials and controlled observational studies that directly evaluated screening for bladder cancer in adults, studies on the diagnostic accuracy of screening tests for bladder cancer, and randomized trials and controlled observational studies on clinical outcomes associated with treatment compared with no treatment of screen-detected or superficial bladder cancer. Data Extraction: Details were abstracted about the patient sample, study design, data analysis, follow-up, and results. Quality was assessed by using methods developed by the U.S. Preventive Services Task Force. Data Synthesis: No randomized trials or high-quality controlled observational studies evaluated clinical outcomes associated with screening compared with no screening or treatment of screen-detected bladder cancer compared with no treatment. No study evaluated the sensitivity or specificity of tests for hematuria, urinary cytology, or other urinary biomarkers for bladder cancer in asymptomatic persons without a history of bladder cancer. The positive predictive value of screening is less than 10% in asymptomatic persons, including higher-risk populations. No study evaluated harms associated with treatment of screen-detected bladder cancer compared with no treatment. Limitation: High-quality evidence was not available for any of the key questions. Conclusion: Additional research is needed to determine whether screening of adults for bladder cancer leads to better outcomes compared with no screening.