The argument against screening for bladder cancer in neuro-urological patients.

Abstract

The objective of this article was to present the case against screening people with neuro-urological disease for bladder cancer. Literature around bladder cancer in neuro-urological patients (primarily spinal cord injured patients [SCI]) was identified. Bladder cancer is more common among patients with spinal cord injury, although the absolute risk is still low (between 0.3 and 0.6%). It is generally an aggressive disease, with atypical pathologic subtypes, and a high risk of mortality. It usually presents 15-30years after SCI, and chronic inflammation of the bladder (due to catheters and urinary infections) may be risk factors. The debate about whether these patients should be screened for bladder cancer has persisted in the literature, and many physicians have justified a yearly cystoscopy as means of screening for bladder cancer. However, when examining the limited direct evidence of screening for bladder cancer, and the requirements for a screening test, it does not appear that bladder cancer screening is a rationale undertaking due to the low incidence, and unclear natural history. However, urologists should continue to be vigilant and appropriately investigate patients with high-risk symptoms such as hematuria, frequent UTIs, scrotal infection, or urethral discharge. The current literature does not support screening patients with SCI for bladder cancer; however, physicians should have a high-evel of suspicion for symptoms suggestive of bladder cancer, and evaluate these at-risk patients promptly.