Bladder cancer control outcomes unimproved over time

Article

Bladder cancer control outcomes have not significantly improved in the United States within the last 30 years.

Washington-Bladder cancer control outcomes have not significantly improved in the United States within the last 30 years, according to a trend analysis reported at the AUA annual meeting in Washington.

The results showed that the age-adjusted incidence rate increased significantly over time in the overall analysis as well as in the subgroups of local and distant-stage disease. However, there was no change in the incidence of regional tumors.

"Our study documented statistically significant changes in three direct outcome measures of bladder cancer. However, the changes are minor and clinically unimportant, and collectively, the data indicate there has been no improvement in bladder cancer detection or mortality rate during the last 30 years," said first author Firas Abdollah, MD, a urology resident at Vita Salute San Raffaele University, Milan, Italy, working with Francesco Montorsi, MD, and colleagues in Montreal; Hamburg, Germany; and New York.

Improved screening needed

Dr. Abdollah suggested that a positive impact on bladder cancer outcomes may await discovery of a marker for early detection.

"Several recent studies suggest a need to modify physician attitudes about bladder cancer screening. This may translate into a reduction in bladder cancer mortality. However, there is also a need for research aimed to identify better strategies for diagnosis of early-stage disease and treatment," Dr. Abdollah said.

In his discussion of the data, Dr. Abdollah provided possible explanations for some of the temporal changes. He noted that the slight increment in the age-adjusted incidence rate of bladder cancer over time may be due to improvement in diagnostic tools, including those that have enabled detection of metastatic disease.

"However, there has been no clinically meaningful change in the incidence of bladder cancer because no cancer-specific marker has been found that allows early diagnosis," he said. "Furthermore, the fact that there has been no change in regional tumor incidence over time indicates there has been no improvement in our ability to capture the tumor while it is still inside the bladder, where it has a better prognosis."

Commenting on the improvement in survival rates, Dr. Abdollah noted these data must be considered cautiously because multiple confounding factors can affect survival outcomes.

"Mortality rate remains the most important measure of progress against any cancer, and in order for changes in survival rates to be meaningful, they should be confirmed by mortality data," he said.

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A recent multicenter study found that robot-assisted radical cystectomy can be performed safely and effectively by urologists who are experienced with robotic surgery. See: http://urologytimes.com/roboticcystectomy.

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