Long-term outcome of home dipstick testing for hematuria.

The most common symptom of bladder cancer (BC) is hematuria and microhematuria will occur in virtually all patients with BC if one tests for it frequently enough. However, hematuria even when caused by serious disease, often is intermittent, and once above some threshold the degree of microhematuria is unrelated to the seriousness of its underlying cause. Based on these principles a BC screening study was conducted to determine if repetitive hematuria testing can detect BC early and whether this resulted in reduced BC mortality, in long-term follow-up compared with disease related outcomes of a contemporary unscreened population similar to the one taking part in screening. The study and the long-term outcomes are reviewed. At 14 years minimum follow-up, none of the 21 men diagnosed with BC by hematuria screening have died of the disease; 12 were still alive and 9 had died of diseases other than BC, with a median survival of 8.8 years. The lower overall mortality in screenees with BC was primarily because of the reduced mortality from BC in that group. Screening had effected a shift of the high grade tumors to earlier (more superficial) stages at diagnosis.