Screening adults for bladder cancer: update of the 2004 evidence review for the U.S. Preventive Services Task Force

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 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.