CTF Summary Table: Screening for Bladder Cancer

Canadian Task Force on Preventive Health Care

Summary Table of Recommendations

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Screening for Bladder Cancer

Prepared by Sarvesh Logsetty, MD, Division of General Surgery, Hospital for Sick Children, Toronto, Ontario

These recommendations were finalized by the Task Force in June 1993

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Urine dipstick or microscopy for hematuria. Urine dipstick testing for hematuria is very sensitive (>98%) with poor specificity (~90%). Cohort studies <8-10> (II-2) Fair evidence to exclude from Periodic Health Examination (PHE) for general population (D); poor evidence to include or exclude from the PHE for persons at high risk.^* (C)

Cytology has low sensitivity (< 90%) and specificity (~90%) and is expensive. Cohort and case-control studies <13> (II-2)

Screening yield is low and there are no studies on effectiveness of early treatment (cases identified by screening).

Intravesical thiotepa and Bacillus Calmette-Guerin (BCG) reduced recurrence rates but no therapeutic agent (intravesical doxorubicin, thiotepa or BCG) has improved long-term survival. Doxorubicin increased side effects. Randomized controlled trials <14-16> (I)

* High-risk groups are Males > 60 years of age who smoke or have smoked, and were employed in a trade that may have exposed them to aromatic amines.

Link to Full Text of this review

Link to Structured Abstract of this review

Link to Selected References list of this review

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
Urine dipstick or microscopy for hematuria.	Urine dipstick testing for hematuria is very sensitive (>98%) with poor specificity (~90%).	Cohort studies <8-10> (II-2)	Fair evidence to exclude from Periodic Health Examination (PHE) for general population (D); poor evidence to include or exclude from the PHE for persons at high risk.^* (C)
	Cytology has low sensitivity (< 90%) and specificity (~90%) and is expensive.	Cohort and case-control studies <13> (II-2)
	Screening yield is low and there are no studies on effectiveness of early treatment (cases identified by screening).
	Intravesical thiotepa and Bacillus Calmette-Guerin (BCG) reduced recurrence rates but no therapeutic agent (intravesical doxorubicin, thiotepa or BCG) has improved long-term survival. Doxorubicin increased side effects.	Randomized controlled trials <14-16> (I)