Bladder cancer screening: lessons from a biologically based model of bladder cancer progression and therapeutic...

The screening of asymptomatic high-risk populations has been evaluated using a biologically based model of bladder cancer. The model is built upon a mathematical representation of the induction of precursor bladder lesions with possible progression through clinical disease states. Screening strategies are based on regimens that include voided urine cytology. Diagnostic and therapeutic components of the model provide the basis for end results evaluation. Cytology screening is projected to increase average life expectancy by 1 to 3 years among those diagnosed while reducing deaths from bladder cancer by more than 50%. The additional contribution to be realized with a screening test of perfect sensitivity would be primarily in the increased identification of dysplasia and low-grade superficial papillary neoplasms, lesions that are much less life-threatening than the high-grade lesions already detectable by cytology. The theoretical potential of screening is not realizable because of diagnostic inaccuracies and treatment failures.