9-16 Dipsticks facilitate testing of serial urine specimens at home, which increases the detection of intermittent hematuria. Although dipsticks are reasonably accurate for detecting hematuria, microscopic hematuria is not specific for bladder cancer or other urologic cancers. The yield of onetime screening for bladder cancer in the general outpatient population appears to be much lower. Urine cytology is more specific but less sensitive than microscopic hematuria as a screen for early bladder cancer. Because cytology is technically difficult and significantly more expensive than dipstick urinalysis, its use as an initial screening test has been limited to high-risk occupational screening programs.
Rapid tests based on other tumor markers are under investigation.
25 Effectiveness of Early Detection Survival in patients with bladder cancer is strongly associated with stage at diagnosis. The rationale for screening is that detecting and treating early asymptomatic bladder cancers may prevent progression to invasive disease, or allow for more effective treatment of noninvasive tumors, which have a high rate of recurrence. Compared to outcomes of cancers developing in the general population, cases detected by screening appeared to be less likely to progress over 3 years 27 or lead to death within 2 years. No major organization recommends screening for bladder cancer in asymptomatic adults. The Canadian Task Force on the Periodic Health Examination recommends against routine screening in asymptomatic individuals and concludes that there is insufficient evidence for or against screening in specific high risk groups.