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Mammograms are all over the news. And now there's a report that maybe we don't need quite so many pap smears. But how much have you heard about screening for kidney and bladder cancer? Together, these cancers kill about 24,000 Americans per year, a rate comparable to breast cancer, which kills about 40,000 American women per year.
These numbers are from the Centers for Disease Control and Prevention, quoted in Reference 2. The authors explain that there are no recommendations to screen the general population for kidney or bladder cancer, because such a screening program would not be cost effective.
Blood in the urine is the primary screening test for urological cancers in women. Urinary tract infections and kidney stones can also produce blood in the urine, and protein in the urine (indicating chronic kidney disease) can produce a false positive test with the dipstick method. For kidney cancer, ultrasound and computed tomography imaging are more specific tests which are much more expensive.
Screening for bladder cancer is recommended for patients with recognized risk factors:
1. Tobacco use
2. Occupational exposure to carcinogenic chemicals
3. Exposure to phenacetin, cyclophosphamide, or pelvic radiation therapy
4. Chronic urinary tract infection
5. Spinal cord injury with intermittent catheterization or indwelling catheter.
Screening for kidney cancer is recommended for patients with a family history of renal cell carcinoma, and for selected patients with end-stage renal disease.
The new mammograms recommendations are similar: screening should be limited to patients with risk above some level considered significant. Reference 2 reports an estimate that mammograms cost $232,000 per “quality-adjusted life-year gained from screening test”. For comparison, the prostate specific antigen test costs $8,700 to $145,000 for the same health benefit, and is recommended for men starting at age 50, and for those at elevated risk starting at age 40.
If we had infinite money available for health care, we might want to screen everyone for every possible cancer. (Assuming the screening tests had zero risks, but this is seldom if ever true.) This is not how we operate in the real world. A 60-year-old woman may have a urological cancer risk higher than the breast cancer risk for a 40-year-old woman. As we debate the mammogram recommendations, I hope we can all keep in mind all the other cancers we want to fight.
References:
1. Mammogram Ruling Backlash:
https://www.empowher.com/news/herarticle/2009/11/18/mammogram-ruling-backlash-shock-anger-and-vows-ignore-new-guidelines?page=0,3
2. Stephenson AJ et al, “Screening for urologic malignancies in primary care: Pros, cons, and recommendations”, Cleveland Clinic Jounal of Medicine 2007 May, 74 Supplement 3: S6-14.
3. Blood in Urine:
https://www.empowher.com/news/herarticle/2009/10/21/blood-urine-do-you-need-specialist
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
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Hi LInda - This was an enlightening article. The ongoing debates over health reform and various screening guidelines are starting to show how much political clout and strong public relations machines affect which cancers get the most attention, research dollars and public interest. It would make a lot more sense to take a more individual and scientific approach that focuses on disease prevention, detection and wellness. Thanks for your insights.
November 27, 2009 - 4:15pmTake good care,
Pat
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