A Simple In-Office Test Is Highly Effective at Detecting Recurrence of Bladder Cancer: JAMA Study
A simple urine test, combined with a visual inspection by a doctor with a cystoscope, can raise the detection of bladder cancer recurrence to 99 percent. That’s the finding of a study in the January 18 issue of the Journal of the American Medical Association.
“Cystoscopy is excellent but not perfect and so this would help when there are equivocal instances where one has any concern that the cystoscopic examination is not absolutely normal,” said Mark S. Soloway, M.D., chairman of the Department of Urology at the University of Miami Leonard M. Miller School of Medicine, who co-authored the study.
Half-a-million Americans have a history of bladder cancer and half will suffer a recurrence of the disease within two years. “Particularly in patients with high-risk bladder cancer who have had their tumor removed but are under very careful surveillance, this will add a level of reliability that the tumor has, in fact, not recurred,” said Soloway, who is also the physician leader of the Prostate, Bladder, and Kidney Cancers Site Disease Group at UM/Sylvester Comprehensive Cancer Center.
The NMP22 test will also be a critical tool for regularly evaluating patients at high risk for bladder cancer: long-time smokers, people who work around particulates in manufacturing, or who work with chemicals like those in hair dyes. “I just had a gentleman here who had no symptoms but he was a cigarette smoker,” said Soloway. “He was feeling fine but he had a bulky tumor. And now despite major surgery he may not be cured, so we need some kind of test like this.”
If detected early, bladder cancer is highly curable, with 94 percent of patients surviving five years or more. But about one in four patients is not diagnosed until the cancer has spread, cutting survival in half. Until now, there has not been a simple in-office test to reliably diagnose this disease.
The advantage to both the patient and the physician is the simplicity of the NMP22 test, which detects a nuclear matrix protein secreted by bladder tumors into urine. A visual inspection requires threading a cystoscope up the urethra into the bladder, and cytology requires an invasive biopsy to retrieve a portion of tissue for a pathologist. Bladder cancer patients undergo these tests as many as four times a year. This test only requires a sample of urine on a test strip, making it a much less invasive way to monitor high-risk patients.
“I think it’s wonderful,” said Elaine Seltzer, who was diagnosed with bladder cancer in June of 2002. “It makes things simpler.” She has a urine sample tested every six months during her regular follow-up visits.
Another advantage to the NMP22 test is that it offers physicians a non-invasive way to distinguish between a common urinary tract infection and this deadly cancer. “Women should be able to, just like they go for a Pap test or a mammogram, have this test,” said Seltzer.
“It’s important because too often we see men and women who have blood in the urine or symptoms that could be bladder cancer treated for infections for several months before they’re diagnosed,” said Soloway. “Unfortunately, those months can make a significant difference in the ability to cure those cancers.”
The American Cancer Society reports that approximately 60,000 Americans will be diagnosed with bladder cancer this year, and nearly 13,000 will die. In Florida, about 4,500 people will be diagnosed with the disease and nearly 1,000 will die. Bladder cancer is the fifth most common cancer in men, eighth most common in women and is largely correlated with cigarette smoking. “If someone is a smoker over 50 they should consider being tested,” said Soloway.
In the JAMA study published on January 18, H. Barton Grossman, M.D. from the M.D. Anderson Cancer Center, Dr. Soloway and colleagues in seven other states followed 668 patients with a history of bladder cancer. Patients provided a urine sample before their regularly scheduled cystoscopy and cytology tests and those urine samples were tested to evaluate the accuracy and reliability of the protein test. Cystoscopy alone revealed 91.3 percent of recurrences, but adding the NMP22 test to cystoscopy raised the diagnosis rate to 99 percent.
After January 18, the study will be available online at http://jama.ama-assn.org/.
UM/Sylvester was founded in 1992 to provide comprehensive cancer services and today serves as the hub for cancer-related research, diagnosis, and treatment at the University of Miami Leonard M. Miller School of Medicine. UM/Sylvester handles more than 1,300 inpatient admissions annually, performs 2,900 surgical procedures, and treats 3,000 new cancer patients. All UM/Sylvester physicians are on the faculty of the Miller School of Medicine, South Florida’s only academic medical center. In addition, UM/Sylvester physicians and scientists are engaged in more than 150 clinical trials and receive more than $31 million annually in research grants. UM/Sylvester at Deerfield Beach recently opened to better meet the needs of residents of Broward and Palm Beach counties. This 10,000-square-foot facility at I-95 and S.W. 10th Street offers appointments with physicians from six cancer specialties, complementary therapies from the Courtelis Center, and education and outreach events.