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In Reply: Patients enrolled in the study investigating the NMP22 assay were evaluated with cystoscopy because of the presence of risk factors that are associated with bladder cancer. Of the 1331 individuals, 91.6% (1220/1331) had hematuria, the most common symptom of bladder cancer. Other risk factors/symptoms included smoking, exposure to carcinogens, and dysuria. Many patients had more than 1 factor (565/1331 [42.4%]), and none were enrolled due to smoking history alone. The enrolling physicians believed that the patients were at sufficient risk to be screened for bladder cancer.

Positive predictive value is related to the prevalence of disease in the studied population. Even in a group at high risk, the prevalence of bladder cancer is low, resulting in a modest positive predictive value (37% for high-risk patients in this study). While many people have a form of bladder cancer that is relatively benign, others have biologically aggressive disease that threatens . . . [Full Text of this Article]

H. Barton Grossman, MD
HBGrossman@mdanderson.org
Department of Urology
M.D. Anderson Cancer Center
Houston, Tex

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