The quality of medical textbooks: bladder cancer diagnosis as a case study

This study was conducted to determine whether there is an inherent bias in medical texts that influences physicians to favor certain signs and symptoms over others when evaluating patients with bladder cancer.

Numerous sources, primarily textbooks from various medical specialties, were reviewed (italics are added for emphasis). Attention was paid to the criteria the authors suggested for use in the diagnosis of bladder cancer.

Although most authors agree on a core of presenting signs and symptoms, some concentrate strongly on hematuria with the result of down playing the importance of other findings such as irritative voiding symptoms. The concern is that this approach may lead to delay in the diagnosis of tumors, some of which may be highly aggressive, which present with dysuria and pyuria but no hematuria.

Inconsistencies do exist in the literature regarding which diagnostic criteria to use in selecting those patients to be evaluated for bladder cancer. Recommendations are made for ways to improve standardization.