1. University Hospitals Portage Medical Center

2. Portage County has one of the highest annual incidence rates of bladder cancer in the state of Ohio. According to the surveillance epidemiology and end result [SEER] from 2007 through 2011 Portage County has an incidence rate of 23.6-26.0/100,000, while the national and Ohio State rates are at 20.6-22.1/100,000. These findings are consistent with prior studies performed by the Ohio Cancer Incidence Surveillance System of 2006, which showed similar higher rates for Ohio as compared to the rest of the US from 1999 to 2003. Bladder cancer is the seventh leading cause of death due to solid organ cancer in the US. Its incident increases with age with nine out of 10 people with cancer being over 55 years of age and the average age at diagnosis is 73 years old. Patients between 80 and 84 years old with bladder cancer are twice those between 65 and 69 years old with more advanced disease. Bladder cancer is the fourth most common cancer in men and men are 3-4 times more susceptible to develop bladder cancer than females. Caucasians have twice the bladder cancer rate of African-Americans but African- Americans are more likely to present with advanced disease.

3.  Incidence in the US is ~ 21 cases/100,000 persons or 0.02%.  It is the seventh-leading cause of death due to solid cancer in the US.  Incidence increases with age:  9 out 10 people with BC > 55.  Average age at diagnosis is 73. [80-84 = 2 X 65-69 year old, & more advanced]  Men are 3-4X > women. 4 th most common cancer in men (ACS estimates)  74,000 new cases (56,320 men & 17,680 women)  16,000 deaths (11,510 men & 4,490 women)  But females have >80 % higher mortality in 1 st year (delayed diagnosis)  Whites 2X > blacks but blacks are more likely to have advanced disease  Usually diagnosed at lower stage (non-invasive or in-situ). Risk factors:  Smoking  Aromatic amines: polyurethane foams, dyes, pesticides, pharmaceuticals and semiconductors  Industries: Rubber, leather, textiles, paint, & printing  Schistosomiasis  Retinoblastoma gene mutation  Cowden Disease (PTEN) mutation & Lynch Syndrome

4. Screening   None of the major professional organizations recommend routine screening of the general public for bladder cancer at this time.   No screening test has been shown to lower the risk of dying from bladder cancer in people who are at average risk.   Urinalysis   Urine cytology   Urine tests for tumor markers:   UroVysion™: This test looks for chromosome changes that are often seen in bladder cancer cells.   BTA tests: These tests look for a substance called bladder tumor- associated antigen (BTA) in the urine.   Immunocyt™: This test looks at cells in the urine for the presence of substances such as mucin and carcinoembryonic antigen (CEA), which are often found on cancer cells.   NMP22 BladderChek®: This test looks for a protein called NMP22 in the urine, which is often found at higher levels in people who have bladder cancer.

5.  Hematuria (>3 RBC/hpf) is present in approximately 21% of the U.S. population, including up to 2% of children.  Up to 3% of adults normally excrete small numbers of RBCs <3  The most common causes of gross hematuria in adults:  urinary tract infection (32.8%),  malignancy (22.5%)  urolithiasis (10.8%).  The most common causes of microscopic hematuria in adults:  idiopathic (no source found after thorough workup) (43.0%)  malignancy (5.1%)  urolithiasis (5.0%)  urinary tract infection (4.3%)  renal disease (2.2%)

6.  Bladder cancer is the most expensive single solid tumor in the US  Estimated annual cost $3 billion (US)  Poor outcome of muscle-invasive disease (<60% survival rate)  In-patients: IMS do urinalysis on all admitted smokers, current or past  If positive for hematuria order urinalysis with microscopy/cytology  Outpatient: Check for Smoking history, history of exposure to cancer causing chemicals, and family history of bladder cancer  Recommend for patients with microhematuria by dipstick to get urinalysis with microscopy/cytology  If still positive for > 3 RBCs/hpf &/or cytology refer to urologist  Smoking prevention program

7. 191/205 cases