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When should a patient with asymptomatic microscopic hematuria be referred for cystoscopy to screen for bladder cancer? To address this question, urologists at Columbia University reviewed records of more than 2000 patients evaluated for asymptomatic microscopic hematuria (defined as ≥3 red cells per high-power field on microscopy). Patients with recent histories of visible hematuria, medical renal disease, infection, or stones were excluded.
Twenty-five patients (1.2%) had bladder cancer at cystoscopy; none were muscle-invasive. Rates were 0.8% in women and 1.9% in men. The youngest man and woman with bladder cancer were 52 and 56, respectively; none of 444 patients who were younger than 50 had bladder cancer. On multivariable analysis, the …