A 72-year-old man comes to the office for a routine preventive visit. The patient feels well and reports no recent health issues. He has a history of hypertension and hyperlipidemia; current medications include hydrochlorothiazide, felodipine, and simvastatin. The patient smoked a pack of cigarettes daily for 40 years but quit 5 years ago. He drinks alcohol occasionally. Vital signs and physical examination are normal. The patient's brother was recently diagnosed with bladder cancer, and the patient asks whether he should be screened for the disease. Which of the following is the most appropriate response to this patient's question?

Question

A 72-year-old man comes to the office for a routine preventive visit.  The patient feels well and reports no recent health issues.  He has a history of hypertension and hyperlipidemia; current medications include hydrochlorothiazide, felodipine, and simvastatin.  The patient smoked a pack of cigarettes daily for 40 years but quit 5 years ago.  He drinks alcohol occasionally.  Vital signs and physical examination are normal.  The patient's brother was recently diagnosed with bladder cancer, and the patient asks whether he should be screened for the disease.  Which of the following is the most appropriate response to this patient's question?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d2e7_b4a6_bc81_39121c1a61b0_MD0003_00 Bladder cancer is the second most common urologic cancer (after prostate cancer) in the United States. Most cases arise in older individuals who have had chronic exposure to chemical carcinogens in tobacco smoke, the workplace (eg, aromatic amines, aluminum), or drinking water (eg, arsenic from well water). Although smoking and a family history of bladder cancer in first-degree relatives are associated with increased risk, multiple studies have found that bladder cancer screening does not provide survival benefit, even among high-risk populations. This is likely due to the following: Current screening tests such as dipstick urinalysis (for hematuria), cytology of urine sediment, and urinary tumor biomarkers have relatively low sensitivity/specificity, leading to missed cases (low sensitivity) or unnecessary workup (false-positive testing). Most bladder cancers are detected at an early stage, progress slowly, and are associated with relatively high rates of 5-year survival; therefore, earlier detection (via screening) provides minimal mortality benefit. Therefore, the United States Preventive Services Task Force does not recommend screening for bladder cancer at any age in any patient group (Choices B, C, D, and E). Educational objective: The risk of bladder cancer is greatest in those with chronic exposure to chemical carcinogens in tobacco smoke, the workplace, or drinking water; family history can also indicate increased risk. However, screening for bladder cancer (eg, urinalysis, urine cytology, tumor markers) has not been shown to improve outcomes and is not recommended. References: Bladder cancer: diagnosis and treatment. (http://www.ncbi.nlm.nih.gov/pubmed/29094888)

A 72-Year-Old Man Comes to the Office for a Routine