By: Barry Stein, M.D., Urologist.
Firefighters are among the most prominent
occupational groups at increased risk for bladder cancer. Surprisingly, many
firefighters and their physicians are unaware of their risk for this cancer. Men
get screened for prostate and colon cancers; they are not immune from lung
cancer if they smoke or are exposed to tobacco smoke; and watch for signs of
skin cancer. Yet, one of the most deadly cancers, if not detected early, is not
on their cancer watch list. Bladder cancer is the forgotten cancer. How can this
be? Unlike the “ribbon cancers” bladder cancer does not have a celebrity face or
spokesperson, or the sponsorship from major pharmaceutical companies. There
aren’t walks or runs, or major news coverage. Bladder cancer is one of the most
deadly cancers, if not detected early and treated while the cancer is still
confined to the bladder lining. If diagnosed in its early stages, bladder cancer
has a five-year survival rate of almost 95%. If diagnosed at an advanced stage,
the five-year survival rate is less than ten percent (10%).
occupational groups at increased risk for bladder cancer. Surprisingly, many
firefighters and their physicians are unaware of their risk for this cancer. Men
get screened for prostate and colon cancers; they are not immune from lung
cancer if they smoke or are exposed to tobacco smoke; and watch for signs of
skin cancer. Yet, one of the most deadly cancers, if not detected early, is not
on their cancer watch list. Bladder cancer is the forgotten cancer. How can this
be? Unlike the “ribbon cancers” bladder cancer does not have a celebrity face or
spokesperson, or the sponsorship from major pharmaceutical companies. There
aren’t walks or runs, or major news coverage. Bladder cancer is one of the most
deadly cancers, if not detected early and treated while the cancer is still
confined to the bladder lining. If diagnosed in its early stages, bladder cancer
has a five-year survival rate of almost 95%. If diagnosed at an advanced stage,
the five-year survival rate is less than ten percent (10%).
Previously, bladder cancer screening required expensive and invasive
testing. Modern technology now allows for simple, inexpensive and noninvasive
screening. It now costs far more to treat one victim of advanced stage bladder
cancer than to screen thousands of firefighters. Studies have shown that
firefighters are twice as likely to have bladder cancer than the general
population. People who are exposed to certain chemicals, burning material, and
soot have a higher risk for the cancer. Prolonged exposure to benzene compounds
found in burning debris is associated with bladder cancer risk. Even though
firefighters wear an air pack, once the fire is knocked down, and they take
their packs off, they are exposed to the smoldering material.
testing. Modern technology now allows for simple, inexpensive and noninvasive
screening. It now costs far more to treat one victim of advanced stage bladder
cancer than to screen thousands of firefighters. Studies have shown that
firefighters are twice as likely to have bladder cancer than the general
population. People who are exposed to certain chemicals, burning material, and
soot have a higher risk for the cancer. Prolonged exposure to benzene compounds
found in burning debris is associated with bladder cancer risk. Even though
firefighters wear an air pack, once the fire is knocked down, and they take
their packs off, they are exposed to the smoldering material.
Are there other risk factors? Cigarette smoking is the most common risk
factor for bladder cancer. In fact, cigarette smokers are 4 to 7 times more
likely to develop bladder cancer than nonsmokers. As physicians, it’s important
that we recognize our role in the early detection of bladder cancer, when it is
most treatable. Although bladder cancer hasn’t been a major focus of men’s
health medicine, it is a serious men’s health issue, especially for
firefighters. Bladder cancer is about as common in men as colon cancer. It also
has the highest recurrence rate of any cancer – even skin cancer. Bladder cancer
is the second most common urologic malignancy in the U.S. (prostate cancer is
the most common). Its prevalence is higher than lung cancer. Today, more than a
half million people have had or are living with bladder cancer. Catch bladder
cancer early Learn the warning signs.
factor for bladder cancer. In fact, cigarette smokers are 4 to 7 times more
likely to develop bladder cancer than nonsmokers. As physicians, it’s important
that we recognize our role in the early detection of bladder cancer, when it is
most treatable. Although bladder cancer hasn’t been a major focus of men’s
health medicine, it is a serious men’s health issue, especially for
firefighters. Bladder cancer is about as common in men as colon cancer. It also
has the highest recurrence rate of any cancer – even skin cancer. Bladder cancer
is the second most common urologic malignancy in the U.S. (prostate cancer is
the most common). Its prevalence is higher than lung cancer. Today, more than a
half million people have had or are living with bladder cancer. Catch bladder
cancer early Learn the warning signs.
One of the first signs is blood in the urine (hematuria). Sometimes the
urine appears normal and blood is detected only through a test. Other signs can
include painful urination, increased frequency of urination, a feeling of
needing to urinate but not being able to do so, and chronic bladder inflammation
from recurrent urinary tract infections. While each of these symptoms might have
benign causes, the possibility of bladder cancer should not be excluded,
especially for those who are at higher risk. Hematuria is the most frequent
symptom of bladder cancer. However, there are many reasons for hematuria,
including urinary tract infections and nephrolithiasis (kidney stones).
urine appears normal and blood is detected only through a test. Other signs can
include painful urination, increased frequency of urination, a feeling of
needing to urinate but not being able to do so, and chronic bladder inflammation
from recurrent urinary tract infections. While each of these symptoms might have
benign causes, the possibility of bladder cancer should not be excluded,
especially for those who are at higher risk. Hematuria is the most frequent
symptom of bladder cancer. However, there are many reasons for hematuria,
including urinary tract infections and nephrolithiasis (kidney stones).
Don’t postpone seeing a doctor or urologist Screening tests have been used
to detect a variety of cancers early in their development in an effort to
improve survival. In the absence of screening, one in four bladder cancers is
detected when it is already advanced, requiring expensive treatment and reduced
survival. We now have the means to screen people at risk for bladder cancer
using a test that detects elevated levels of the NMP22 protein marker in a
single urine sample. Most healthy individuals have very small amounts of the
NMP22 protein marker in their urine, but bladder cancer patients commonly have
elevated levels, even at early stages of the disease. The test is done in the
doctor’s office and we have results during the patient’s visit. If the test is
positive, the individual should be further evaluated for bladder cancer by a
urologist.
to detect a variety of cancers early in their development in an effort to
improve survival. In the absence of screening, one in four bladder cancers is
detected when it is already advanced, requiring expensive treatment and reduced
survival. We now have the means to screen people at risk for bladder cancer
using a test that detects elevated levels of the NMP22 protein marker in a
single urine sample. Most healthy individuals have very small amounts of the
NMP22 protein marker in their urine, but bladder cancer patients commonly have
elevated levels, even at early stages of the disease. The test is done in the
doctor’s office and we have results during the patient’s visit. If the test is
positive, the individual should be further evaluated for bladder cancer by a
urologist.
Although we still have a way to go, progress is being made, albeit slowly,
in raising the awareness of the risk of bladder cancer. In San Francisco,
doctors screened more than 1,000 active and retired firefighters for bladder
cancer. The results of the testing confirmed that firefighters may be at an
increased risk of developing transitional cell carcinoma (TCC, or bladder
cancer) and should be considered for routine annual screening. And, in a number
of smaller communities throughout the country, other voluntary screenings of
firefighters have occurred. Legislation was just passed in my home state of
Rhode Island creating a firefighters cancer wellness program. The program
emphasizes the need for both annual testing and keeping firefighters informed
about developments concerning links between firefighters’ exposure to hazardous
materials and bladder cancer.
in raising the awareness of the risk of bladder cancer. In San Francisco,
doctors screened more than 1,000 active and retired firefighters for bladder
cancer. The results of the testing confirmed that firefighters may be at an
increased risk of developing transitional cell carcinoma (TCC, or bladder
cancer) and should be considered for routine annual screening. And, in a number
of smaller communities throughout the country, other voluntary screenings of
firefighters have occurred. Legislation was just passed in my home state of
Rhode Island creating a firefighters cancer wellness program. The program
emphasizes the need for both annual testing and keeping firefighters informed
about developments concerning links between firefighters’ exposure to hazardous
materials and bladder cancer.
We know the risk factors and signs of bladder cancer. Even if the
celebrities aren’t speaking out, as physicians we have an obligation to educate
each other and our patients. We now have the means to screen people at-risk for
bladder cancer. Let’s tell them about it, so they can do something about it.
Bladder cancer can be detected early. At the first sign, see your doctor. Know
these facts: • Firefighters are twice as likely than the general population to
have bladder cancer • More prevalent in men than women • Almost as prevalent as
colon cancer in American males • Smoking, major risk factor • Blood in urine,
most frequent symptom.
celebrities aren’t speaking out, as physicians we have an obligation to educate
each other and our patients. We now have the means to screen people at-risk for
bladder cancer. Let’s tell them about it, so they can do something about it.
Bladder cancer can be detected early. At the first sign, see your doctor. Know
these facts: • Firefighters are twice as likely than the general population to
have bladder cancer • More prevalent in men than women • Almost as prevalent as
colon cancer in American males • Smoking, major risk factor • Blood in urine,
most frequent symptom.
Other signs – painful urination, frequency, urge • Bladder cancer has the
highest cost per patient of all cancers from diagnosis to death. It is estimated
that the annual direct costs of bladder cancer management are $4 billion.
highest cost per patient of all cancers from diagnosis to death. It is estimated
that the annual direct costs of bladder cancer management are $4 billion.
About the author: Barry Stein, M.D., a urologist in Providence, RI, has
advocated for early detection and education of bladder cancer for many years.
Most recently he participated as a medical advisor for the kick-off of the
firefighter screening program in Rhode Island. Dr. Stein is a co-author of
several medical studies regarding bladder cancer diagnosis and surveillance and
has spoken to groups on the subject.
advocated for early detection and education of bladder cancer for many years.
Most recently he participated as a medical advisor for the kick-off of the
firefighter screening program in Rhode Island. Dr. Stein is a co-author of
several medical studies regarding bladder cancer diagnosis and surveillance and
has spoken to groups on the subject.