New Cancer Testing Guidelines May Be Needed

Urinary tract cancers risks predicted with Hematuria Risk Index

(RxWiki News) Blood in the urine demands that a doctor rule out several health conditions, including cancer. Investigators developed a tool that can accurately predict cancer risk among people with this symptom.

Only a small number of people with microscopic blood in the urine (hematuria) actually have urinary tract cancer. Researchers have found that tiny amounts of blood in the urine may not necessarily mean more testing is needed.

A new tool has been developed and tested - Hematuria Risk Index – that is effective in predicting urinary tract (UT) cancer risk. Such a tool, along with follow-up testing guideline changes, could save patients unnecessary and expensive evaluations that can expose them to radiation.

"Ask your doctor why a test is being ordered."

Steven J. Jacobsen, MD, PhD, of Kaiser Permanente Southern California, led the two-year study.

The American Urological Association (AUA) currently recommends that patients with microscopic hematuria undergo a number of tests, even if they’re not having any other symptoms. These tests may include more urine testing and a CT (computed tomography) scan of the abdomen. A special X-ray exam of the urinary tract, plus an ultrasound of the kidney may be ordered. Doctors may also perform a cystoscopy in which a camera is used to examine the bladder and urethra (tube that carries urine outside the body).

Earlier research found that this testing isn’t very good at identifying people who are most likely to have cancer of the kidney, bladder or urethra.

For this study, investigators followed a group of 2,630 people with microscopic hematuria by observing their electronic medical records for two years. Risk factors that were evaluated included the extent of hematuria, history of smoking and test findings.

Within the study group, 2.1 percent of patients had a neoplasm, a tumor that can be either cancerous or non-cancerous, and 1.9 percent of the individuals had a confirmed urinary tract cancer.

The most telling predictors of cancer included a recent diagnosis of gross (major) hematuria, being male and being 50 years of age of older. Smoking history was not statistically significant.

Based on these findings, investigators created the Hematuria Risk Index to predict cancer risk. The tool proved to be effective with a group of 1784 patients who served to validate the test.

The Index identified 32 percent of these individuals to be at low-risk for developing UT cancer, with 0.2 percent of them receiving a positive diagnosis. The tool also classified 14 percent of the patients as high risk, and 11.1 percent of these folks were diagnosed with a UT cancer.

Dr. Jacobsen said in a statement, "These data confirm that a large number of follow-up examinations could be safely avoided. Patients with microscopic hematuria younger than 50 years and with no history of gross hematuria may not benefit from further evaluation and therefore could avoid unnecessary risk from radiation exposure and invasive endoscopy." 

E. David Crawford, MD, professor of surgery, urology, and radiation oncology, and head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center (UCHSC) in Denver, told dailyRx News, “The real issue here is medical and legal - a 2 percent risk and guidelines that say you should screen are enough to lose a medical legal case. So in the future, guidelines need to be re-evaluated,” Dr. Crawford said, adding “I like the concept of a hematuria risk index to further reduce the false positives.”

This study is published in the February Mayo Clinic Proceedings. The research was funded from internal infrastructure from the Department of Research and Evaluation, Kaiser Permanente Southern California. No conflicts of interest were reported.

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Review Date: 
January 10, 2013