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Invited Commentary
July 29, 2019

Hematuria Practice Guidelines That Explicitly Consider Harms and Costs

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco, San Francisco
  • 2Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 3Department of Urology, University of California, San Francisco, San Francisco
  • 4Deputy Editor, JAMA Internal Medicine
JAMA Intern Med. 2019;179(10):1362-1364. doi:10.1001/jamainternmed.2019.2269

Hematuria is prevalent in up to a third of the US population.1 Approximately 2% to 5% of patients with microscopic hematuria and 12% of patients with macroscopic or gross hematuria will be diagnosed with urinary tract cancer, most cases of which are superficial bladder tumors detected through cystoscopy.2 Screening asymptomatic persons for bladder cancer with urinalysis to detect microscopic hematuria is not recommended by the US Preventive Services Task Force because of insufficient evidence of the advantage of treatment of screen-detected bladder cancer, as well as insufficient data on the harms of screening for and evaluating hematuria.3 There are also no acceptable screening tests for renal cell carcinoma, the predominant cancer detected through imaging during the evaluation for hematuria. However, with the widespread use of urinalysis and high prevalence of hematuria, many patients are evaluated for incidental findings of hematuria.

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