Invisible Blood in Urine May be an Early Indicator and Warning Sign of Bladder Cancer

New research published in the September 1, 2014 edition of the British Journal of General Practice shows that invisible blood in urine, called non-visible hematuria, may be an early warning sign of bladder cancer is likely to shape guidelines for clinicians. [1]

Bladder cancer is the seventh most common cancer in the UK (2011). The disease accounts for 3% of all new cases of cancer. In males, it is the fourth most common cancer (4% of male total), while it is the 13th most common cancer in females (2% of female total). In real numbers, around 10,000 people in the UK are diagnosed with bladder cancer each year, resulting in more than 5,000 deaths. Worldwide, bladder cancer accounts for over 150,000 deaths per year. [2][3][4] The condition is more common in men than women and in older people, with the average age of diagnosis at 68. Smoking is among the main causes.

Mortality, as a result of bladder cancer, is strongly associated to the disease stage at diagnosis - tumors that have invaded muscle resulting in a poor prognosis. In the United Kingdom, 56.1% of adult bladder cancer patients (58.2% of men and 50.2% of women) survived their cancer for five years or more in 2005-2009. To days, no screening is available. Diagnosis relies, therefore, on symptomatic presentation, generally to primary care [2][5]


Early diagnosis of bladder cancer is crucial ... we hope that these findings will lead to robust guidance...


Scientists at the University of Exeter Medical School found that one in 60 people over the age of 60 who had invisible blood in their urine (as identified by their GP) transpired to have bladder cancer. The figure was around half those who had visible blood in their urine – the best known indicator of bladder cancer. However, it was still higher than figures for other potential symptoms of bladder cancer that warrant further investigation.

Indicating bladder cancer
Lead author Sarah Price, a PhD student at the University of Exeter Medical School, led the first robust study to investigate whether invisible blood in urine can indicate bladder cancer.

Commenting on the study results, Price said: "It is well known that if you see blood in your urine you should contact your GP, who is likely to refer you for tests. But there is no clear guidance for GPs on what to do if they detect blood that is not visible during routine tests. We are hopeful that our findings will now lead to robust guidance that it warrants further investigation. Early diagnosis is crucial to have the best chance of successfully treating bladder cancer. The three-quarters of patients who are diagnosed early have much better outcomes than those whose disease is diagnosed late. Anything we can do to boost early detection is crucial to help save lives."

Study design
In the this study, the researchers examined more than 26,000 people whose anonymised data came from the Clinical Practice Research Datalink, a large research database used by the Exeter team in several cancer studies. The data included information from 4,915 patients (aged ≥40 years) diagnosed with bladder cancer between January 2000 and December 2009 matched to 21,718 controls for age, sex, and practice.

Using a multivariable conditional logistic regression, followed by estimation of positive predictive values (PPVs) for bladder cancer using Bayes’ theorem, the team found that the risk of bladder cancer was 1.6% in people over 60 who had invisible blood in their urine.

For more information:
[1] Price SJ, Shephard EA, Barraclough K, Hamilton WT. Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. BJGP September 1, 2014 vol. 64 no. 626 e584-e589. 10.3399/bjgp14X681409 [Article]
[2] Shephard EA, Stapley S, Neal RD, Rose P, Walter FM, Hamilton WT. Clinical features of bladder cancer in primary care. Br J Gen Pract. 2012 Sep;62(602):e598-604. doi: 10.3399/bjgp12X654560.[Article][PubMed]
[3] Estimated incidence, mortality & prevalence in men, 2012; International Agency for Research on Cancer (IARC). Last accessed, August, 31, 2014. [Website]
[4] Cancer Registration Statistics, England, 2011, Office for National Statistics. Last accessed August 31, 2014 [Download PDF]
[5] Cancer Research UK (2011) Cancerstats. Last accessed August 31, 2014 [Website]

This article was updated on September 1, 2014

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