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Invited Commentary
Less Is More
June 2017

Asymptomatic Microscopic Hematuria—Rethinking the Diagnostic Algorithm

Author Affiliations
  • 1Departments of Obstetrics, Gynecology & Reproductive Sciences, Urology, and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
  • 2Medicine Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 3Department of Medicine, University of California, San Francisco, San Francisco, California
JAMA Intern Med. 2017;177(6):808-809. doi:10.1001/jamainternmed.2017.0758

Asymptomatic microscopic hematuria (AMH) is a common problem that can occasionally be a marker of severe disease, including urinary tract cancer. Although there are some areas of agreement related to the definition and evaluation of AMH, there remains considerable discussion regarding the need for evaluation of AMH and the most accurate and cost-effective tests. To a large extent, this disagreement is owing to limited evidence on the accuracy of available tests to identify cancer, and to the complete lack of evidence regarding the benefit of identifying urologic cancer before the patient becomes symptomatic. In this issue of JAMA Internal Medicine, Halpern et al1 add to the discussion by presenting estimates of the effectiveness and cost per cancer detected for 4 common approaches to the evaluation of AMH.