Fradet Yves
University of Laval, Québec, QC.
Can Urol Assoc J. 2009 Dec;3(6 Suppl 4):S180-3. doi: 10.5489/cuaj.1192.
Bladder cancer kills more women than cervical cancer and is also a significant cause of mortality in men. Little progress has been made in improving survival in patients with advanced bladder cancer. Two pilot studies using microhematuria screening have shown that screening for bladder cancer results in close to 80% downstaging, with high-grade cancers being detected before they have invaded the bladder wall. Results of long-term follow-up even suggest a striking reduction in bladder cancer mortality. The main obstacles to screening for bladder cancer may be overcome if a higher-risk population is identified by designing a risk scale for exposure to cigarette smoke and occupational carcinogens, and through genetic testing for susceptibility to cancer and home hematuria screening, which in itself identifies a population with approximately 3% to 4% risk of bladder cancer. The feasibility and cost effectiveness of screening for bladder cancer can be significantly improved by incorporating a secondary screening strategy using a more sensitive and specific bladder cancer marker that is currently available, and by limiting urological evaluations to patients who show positive results on one or more of these tests. Bladder cancer is the most costly cancer to treat in the United States and pharmacoeconomic studies suggest that screening for bladder cancer could not only save lives but also reduce costs per year-life saved. A pilot study is underway and the urology community should be very supportive of studies to validate this opportunity.
膀胱癌导致死亡的女性人数超过宫颈癌，也是男性死亡的重要原因。晚期膀胱癌患者的生存率改善进展甚微。两项使用微量血尿筛查的试点研究表明，膀胱癌筛查可使分期降低近80%，能在高级别癌症侵犯膀胱壁之前检测到它们。长期随访结果甚至表明膀胱癌死亡率显著降低。如果通过设计接触香烟烟雾和职业致癌物的风险量表，并通过癌症易感性基因检测和家庭血尿筛查来识别高风险人群，就可能克服膀胱癌筛查的主要障碍，家庭血尿筛查本身就能识别出患膀胱癌风险约为3%至4%的人群。通过采用目前可用的更敏感、更特异的膀胱癌标志物纳入二级筛查策略，并将泌尿外科评估限于在这些检测中一项或多项呈阳性结果的患者，可显著提高膀胱癌筛查的可行性和成本效益。在美国，膀胱癌是治疗成本最高的癌症，药物经济学研究表明，膀胱癌筛查不仅可以挽救生命，还能降低每年挽救生命的成本。一项试点研究正在进行中，泌尿外科界应该非常支持验证这一机会的研究。
