NEW ORLEANS—Other smoking-related illnesses exceed bladder cancer as the cause of death of patients previously screened because they were at high risk for the malignancy, according to new research presented at the American Urological Association meeting 2015. 

Investigators examined a bladder cancer screening cohort consisting of 925 individuals older than 50 years who were at high risk of bladder cancer due to a history of smoking (10 or more pack-years) and/or long-term occupational exposure to chemicals (15 or more years). A full 96% of patients had been smokers. The nuclear matrix protein assay (NMP-22) was used for screening.

About 6% received a positive result from the NMP-22 test, but only 0.2% were found to actually have bladder cancer. During a median of 6.5 years, 9 additional patients with an initial negative NMP-22 test result were diagnosed with bladder cancer.

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All bladder cancers were non-invasive and the majority of them were low grade (64%). “The low prevalence of invasive disease in this cohort may be due to prior urinalysis-based screening or urinalysis screening after the NMP-22 test,” explained researcher Yair Lotan, MD, chief of urologic oncology at the University of Texas Southwestern Medical Center at Dallas.

A total of 134 patients eventually died, including 1% from lung cancer and 0.3% from renal cell carcinoma. None had succumbed to bladder cancer.

“Lung cancer diagnosis, hematuria of any kind, and greater than 60 pack-year smoking history were independently associated with increased risk of mortality,” Dr. Lotan told Renal & Urology News. “Competing risks of mortality are therefore an important consideration in future bladder cancer screening trials.”

Hematuria was likely due to confounding factors not measured in this study, he said.