Determining lung cancer screening eligibility in a surgically treated urothelial carcinoma population: Making the case for linking bladder cancer screening to lung cancer screening.
Authors: Arora Aman , Kopelevich Alexei , Ly Serena , Ojla Dharminder Singh , Goldberg Hanan , Dall'era Marc , Chandrasekar Thenappan 
Published: February 2025

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Background:
Bladder cancer is the 10th most common cancer globally, with 573,278 cases reported in 2020. Tobacco consumption is a major risk factor; smokers have a 3x higher risk of bladder cancer compared to non-smokers. Tobacco consumption is also a risk factor for lung cancer, and current guidelines recommend screening high risk patients. While screening for bladder cancer in the general population is not recommended, screening high-risk bladder cancer populations may be beneficial. We hypothesize that linking bladder cancer screening to lung cancer screening may have higher yield than general population screening and enable earlier bladder cancer diagnosis.
Methods:
We performed a retrospective review of patients at a single-institution that underwent surgical treatment for urothelial carcinoma (TURBT, ureteroscopy, ureterectomy, nephroureterectomy, or cystectomy) by a single urologic-oncologist from October 2022 to June 2024. Patients were initially referred for microscopic/gross hematuria, badder/upper tract mass, or known urothelial cancer. We collected patient demographics, smoking history and imaging/surgical pathology. We aimed to determine the eligibility of these patients for lung cancer screening programs. Secondary outcomes included rates of lung cancer screening and lung cancer diagnosis.
Results:
We identified 76 patients with a urothelial carcinoma diagnosis. 87% had bladder cancer and 13% had UTUC. 48 (63%) patients were either current or former smokers, and the mean pack year history was 24 pack years. Of those patients, 14 (29%) met the criteria for lung cancer screening guidelines (ages 50-80, at least a 20 pack year smoking history, and current smoker or quit within 15 years); only 1 patient (7%) had received a screening low-dose CT Chest for lung cancer screening. Out of these 14 patients, 11 (79%) had a concerning finding on CTU.
Conclusions:
Our analysis highlights that lung cancer screening uptake remains low. In our cohort, 29% met lung cancer screening guidelines at the time of diagnosis. In this high risk population, 79% had concerning findings on CTU. While our results are promising and establish a potential rationale for linking bladder cancer screening to lung cancer screening due to their higher inherent risk, future prospective studies are needed to demonstrate utility and benefit.

Patient demographic information.

No Smoking History (N = 28)
Smoking History (N = 48)
Overall (N = 76)

Age, Mean (SD)
72.5 (12.2)
72 (9.9)
72.2 (10)

Sex (%)

Male
20 (71.4%)
35 (72.9%)
55 (72.4%)

Female
8 (28.6%)
13 (27.1%)
21 (27.6%)

Gross Hematuria Upon Presentation
12 (42.9%)
36 (75.0%)
48 (63.2%)

Concerning CTU Findings
14 (50.0%)
31 (64.5%)
45 (59.2%)

Taking Blood Thinners
11 (39.2%)
18 (37.5%)
29 (38.2%)

CAD/Afibb/Stroke/PE
13 (46.4%)
19 (39.6%)
32 (42.1%)

HTN/DM
17 (61%)
25 (52%)
42 (55.2%)