Screening for bladder cancer in high-risk groups: delineation of the problem.

Since 1895, various exogenous chemicals and occupations have been identified as risk factors for bladder cancer. The aromatic amines are among the most notable chemicals. To date, numerous groups of workers and, in some cases, community residents, who are at increased risk of bladder cancer have come to the attention of health officials and have sought guidance concerning screening for bladder cancer. Most of these persons are asymptomatic, but they may not have attained the average length of preclinical latency for aromatic amine-induced cancer. Although the principal public health strategy for combatting occupational exposure to carcinogens is primary prevention, screening is another strategy that can be used for those already exposed to known or suspected carcinogens. Screening also can be used to assess whether or not environmental controls are needed or need to be improved. For more than a decade the question of screening has been problematic with regard to occupational groups where known exposures have been documented. The question facing government, labor, industry, and academia is what to recommend with regard to screening high-risk groups.