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One of the difficulties in ascertaining the ability of asymptomatic microhematuria to predict the existence of renal or uroepithelial cancer is that the gold standard of diagnosis, excretory urography and cystoscopy, entails risks. The ethics of studies in man would generally preclude performances of these tests on all asymptomatic adults with one or more red blood cells per high-power field on urinalyses. However, the results of such tests on a high-risk subgroup, such as patients whom physicians have referred to urologists, cannot be applied to the general population. Thus, one must study a defined general population by observing the appearance of disease after an abnormal urinalysis result. Dr Heller must have overlooked our reporting on page 227 of patients who had urologic tests in the month after their urinalysis, but this does not resolve his legitimate concern that hematuria may be a clue to the preclinical phase of
Mohr DN, Offord KP, Melton LJ. Asymptomatic Microhematuria and Urologic Disease-Reply. JAMA. 1986;256(19):2674–2675. doi:10.1001/jama.1986.03380190044012
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