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Prospektive Studie UroScreen
Früherkennung von Harnblasenkarzinomen mit Tumormarkern in einem Kollektiv mit vorheriger beruflicher Exposition gegenüber aromatischen Aminen

Aim: The prospective study UroScreen aims to assess whether bladder tumours are recognized more readily in a high-risk population by the use of urinary tumour markers than by haematuria or abnormal cytology.

Method: Since 2003, UroScreen has been included in the medical surveillance programme carried out according to the guideline G33. Once annually, 1772 workers with previous exposure to aromatic amines are offered the quantitative determination of nuclear matrix protein NMP22 and survivin and the UroVysionTM test for chromosomal aberrations in addition to urinalysis and cytology.

Results: As of February 2009, 1600 subjects had been enrolled in at least one screening session. For the 5785 urine tests, positive results were found in 199 (3.5 %) NMP22 assays, 113 (2.3 %) survivin assays, especially in subjects with urinary tract infections (UTI) which are considered as a criterion for exclusion of the NMP22 test but cannot always be handled in this way. UTI occur commonly in medical practice but compliance for control investigations is poor. Positive results in the UroVysionTM test were obtained for 55 (1.0 %) of samples, in some cases together with abnormal cytology findings. For samples yielding positive results in the tests, including cytology but excluding survivin, cystoscopy was recommended. To date, 15 tumours have been found in 14 subjects, and for 11 of them a positive test result had been obtained in the preceding marker screening. The protein-based (NMP22, survivin) and cell-based tests (UroVysionTM, cytology) complemented each other here.

Conclusions: The preliminary UroScreen results indicate that a marker panel with protein- and cell-based markers can improve early detection of bladder cancer. The experience gained through this extensive prospective study could also help in the resetting of cut-offs for quantitative markers and in deciding when to recommend invasive cystoscopy.