Have visible blood in urine checked, even if painless or gone the next day
After visible blood in urine, about 2.8% of people over 60 and 1.2% of those aged 40–59 were ultimately found to have bladder cancer. That is not a high percentage, but it is high enough to warrant a check—even if the bleeding stops the next day.
What it takes
In China, urinalysis costs a few dozen renminbi, urinary-tract ultrasound RMB 100–200, and cystoscopy around RMB 1,000 if the clinician considers it necessary.
What you may gain
A UK primary-care electronic-record study compared 4,915 bladder cancer cases with 21,718 controls. The positive predictive value of visible hematuria—the proportion ultimately found to have bladder cancer—was 2.8% after age 60 (95% CI 2.5–3.1) and 1.2% at ages 40–59 (CI 0.6–2.3). Microscopic blood also mattered: OR 20, 95% CI 12–33; its positive predictive value after 60 was 1.6%, CI 1.2–2.1.
Context & considerations
The absence of pain matters. Stones and infection often cause flank or abdominal colic, urinary frequency, urgency or pain. Tumor-related bleeding is often painless and may stop for days before returning, which makes it easy to dismiss. Taking anticoagulants is no reason to skip evaluation. Blood after strenuous exercise or around menstruation can be retested before deciding the next step. The benefit rating is small because the evidence gives detection rates, not an estimate of deaths prevented by earlier testing.
Research & references
Price SJ, Shephard EA, Stapley SA, Barraclough K, Hamilton WT (2014). Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. British Journal of General Practice, 64(626), e584-e589. https://doi.org/10.3399/bjgp14X681409