Patients screened for bladder cancer because they are at high risk for the malignancy rarely develop muscle-invasive disease and are more likely to die from other causes, according to a new study.

A team at the University of Texas Southwestern Medical Center in Dallas led by Yair Lotan, MD, analyzed a cohort of 925 patients considered at high risk of bladder cancer because of smoking, potential chemical carcinogen exposure, or both. The group included 886 smokers (95.8%) and 613 (66.3%) who had hazardous occupational exposure. At an initial screening, 57 patients had a positive nuclear matrix protein 22 test and 2 had bladder cancer.

During a median follow-up of 78.4 months, another 9 patients (1%) were diagnosed with bladder cancer; all cases were non-invasive, with 7 low-grade and 4 high-grade cancers, Dr. Lotan’s group reported online ahead of print in BJU International. “The low prevalence of invasive disease in this cohort may be attributable to previous or more frequent post-screening urine analysis-based screening,” the authors wrote.

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Renal cell carcinoma (RCC) was diagnosed in 10 patients (1.1%) and lung cancer was diagnosed in 18 (1.9%). Of the 925 patients, 134 died, including 3 from RCC and 12 from lung cancer. No patient died from bladder cancer.

“Competing risks of mortality are therefore an important consideration for future bladder cancer screening trials,” the authors concluded.

On multivariable analysis, lung cancer, hematuria, and more than 60 pack-years of smoking independently predicted mortality.