yair lotan

MD

University of Texas Southwestern Medical Center

Professor of Urology

NLST (Learn more about this study)

NLST-31

Aug 7, 2013

Addressing Knowledge Gaps in Bladder Cancer Screening

Urothelial carcinoma of the bladder (BCa) is the 5th most common cancer worldwide with an estimated 73,510 cases and 14,880 deaths in the U.S. for 2012. About 25% of tumours are muscle invasive or metastatic at diagnosis and have a poor prognosis with less than 50% survival. This outcome has not improved over the last 25 years , suggesting methods to downstage tumours at diagnosis and improve treatment are required. Most muscle invasive BCa’s are identified at diagnosis rather than following progression of nonmuscle invasive disease (NMI). Thus, earlier diagnosis could reduce invasion, metastasis and mortality. Several single arm screening studies have found that screening can detect cancers prior to muscle invasion. For example, Messing et al. found that men screened for dipstick hematuria had similar rates of high grade NMI BCa compared to unscreened men, but fewer tumours with muscle invasion, suggestive of screening driven downstaging. Incidental BCa is rarely found at autopsy. This suggests little pre-clinical, latent phase cancer and so overdiagnosis with screening is unlikely. Overtreatment is also unlikely, given that most cancers become symptomatic.
The risk factors for bladder cancer are known including male gender, age, and smoking history. The questions we seek to address include determining the true incidence of bladder cancer in a high risk cohort of subjects with a history of heavy smoking,
We will try to identify the risk of bladder cancer in the NLST stratified by age, gender and smoking history to try to identify those subjects with highest risk of bladder cancer. This will help identify the highest risk patients for a possible bladder cancer screening trial.