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Screening Adults for Bladder Cancer

Update of the 2004 Evidence Review for the US Preventive Services Task Force

Evidence Syntheses, No. 78

Investigators: , MD and , MLS.

Oregon Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 11-05148-EF-1

Structured Abstract

Background:

Bladder cancer is one of the 10 most frequently diagnosed cancers. 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 (USPSTF) evidence review on screening for bladder cancer in adults in primary care settings.

Data Sources:

We searched Ovid MEDLINE from 2002 to December 2009, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials through the fourth quarter of 2009, and the CancerLit subsection of PubMed through March 2010 to identify relevant articles. We identified additional studies from citations in relevant articles, including the previous USPSTF review. Searches were limited to English-language studies.

Study Selection:

We selected randomized trials and controlled observational studies that directly evaluated screening for bladder cancer in adults. To evaluate indirect evidence on screening, we also included studies on the diagnostic accuracy of screening tests for bladder cancer, and randomized trials and controlled observational studies that reported clinical outcomes associated with treatment compared to no treatment in patients with screen-detected or superficial bladder cancer.

Data Extraction:

One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF.

Data Synthesis:

No randomized trials or high-quality controlled observational studies evaluated clinical outcomes associated with screening compared to no screening, or treatment of screen-detected bladder cancer compared to no treatment. No study evaluated the sensitivity or specificity of tests for hematuria, urinary cytology, or urinary biomarkers for bladder cancer in asymptomatic persons without a prior history of bladder cancer. The positive predictive value of screening is <10 percent in asymptomatic persons, including higher-risk populations. No study evaluated harms associated with treatment for screen-detected bladder cancer compared to no treatment.

Limitations:

High-quality evidence was not available for any of the key questions.

Conclusions:

Additional research is needed to determine whether screening of adults for bladder cancer leads to better outcomes compared to no screening.

Contents

Oregon Health & Science University, Mail Code BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098. www​.ohsu.edu/epc

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Acknowledgements: The authors acknowledge Christina Bougatsos, BS, Oregon Health & Science University, for assistance with the report; the expert reviewers of the draft report; AHRQ Medical Officer Iris Mabry-Hernandez, MD, MPH; and U.S. Preventive Services Task Force leads Thomas G DeWitt, MD, Diana B Petitti, MD, MPH, and Timothy Wilt, MD, MPH, for their contributions to this report.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC)1 under contract to the Agency for Healthcare Research and Quality (AHRQ),2 Rockville, MD (Contract No. 290-2007-10057-I-EPC3, Task Order Number 3).

Suggested citation:

Chou R, Dana T. Screening Adults for Bladder Cancer: Update of the 2004 Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 78. AHRQ Publication No. 11-05148-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; October 2010.

The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

Oregon Health & Science University, Mail Code BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098. www​.ohsu.edu/epc

2

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK47510PMID: 21028757
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