This is a free electronic newsletter that is published by the Ostomy Association of Southwestern Indiana. The January issue addresses a lot of the issues connected with an ostomy and a special section for Urinary Ostomies. You can sign up to get the newsletter if you wish. The link is below:
Study finds nitrates increase bladder cancer risk. (EH Update)
Study finds nitrates increase bladdercancer risk. (EH Update)
Full Text: COPYRIGHT 2004 National Environmental Health Association
Nitrate in drinking water is associated with an increased risk of bladdercancer, according to a University of Iowa (UI) study that looked at cancer incidence among nearly 22,000 Iowa women.
The study results suggest that even low-level exposure to nitrates over many years could increase certain types of cancer, said Peter Weyer, associate director of the UI Center for Health Effects of Environmental Contamination (CHEEC) and one of the lead authors. The study was published in the May 2001 issue of the journal Epidemiology.
"The positive association we found between nitrate contamination in drinking water and bladdercancer is consistent with some previous data. However, this is something that warrants follow-up research," said Weyer, who co-authored the article with James R. Cerhan, M.D., Ph.D., an investigator with the department of health sciences research at the Mayo Clinic in Rochester, Minnesota.
The researchers assessed nitrate exposure from drinking water in 21,977 women who were participants in the Iowa Women's Health Study. The women were between 55 and 69 years of age in 1986 (at the start of the study). They resided in a total of 400 Iowa communities and had used the same drinking-water supply for more than 10 years. Approximately 16,500 of the women received their water from municipal water supplies; the remaining women used private wells.
No individual water consumption data were available, so the researchers assigned each woman an average level of exposure to nitrate. The assigned levels were based on data collected between 1955 to 1988 on nitrate levels in the community water supply each woman used. No nitrate data were available for women who used private wells.
The researchers used cancer incidence data from the Iowa Cancer Registry for 1986 to 1998 and adjusted for factors such as smoking and nitrate in the diet. They found a greater risk for bladdercancer as the nitrate levels in the community water supplies increased. Women whose average drinking-water nitrate exposure level was greater than 2.46 milligrams per liter (mg/L) (nitrate-nitrogen) were 2.83 times more likely to develop bladdercancer than women with the lowest level of nitrate exposure (less than 0.36 mg/L).
Nitrate is produced naturally within the body; environmental sources include food (including many vegetables), contaminated drinking water, cigarette smoking, and certain medications. Drinking water can account for a substantial proportion of the total nitrate intake. Up to 20 percent of ingested nitrate is transformed in the body to nitrite, which can then undergo transformation in the stomach, colon, and bladder to form N-nitroso compounds. These compounds are known to cause cancer in a variety of organs in more than 40 animal species, including higher primates.
Weyer emphasized that additional studies are needed to look at possible links between nitrate levels in drinking water and cancer, particularly with respect to refining exposure assessments.
"From a public health perspective, source water protection is a main concern. Sources of nitrate that can affect water supplies include fertilizers, human waste, and animal waste," he said. "All of us, rural and urban residents alike, need to be more aware of how what we do as individuals can affect our water sources and, potentially, our health."
For more information about this study, e-mail firstname.lastname@example.org or call (888) 648-7283.
Study in the Journal of American Medical Association (JAMA) Reports Significant Improvement in Bladder Cancer Detection – 99% of Malignancies Found
JAMA Reports that the NMP22® BladderChek® Test is Better at Detecting Bladder Malignancies than Current Technologies
NEWTON, Mass. —January 17, 2006 — A simple point-of-care urine test, the NMP22 BladderChek Test, was found to significantly increase the detection of recurrent bladder cancer, finding 99% of the malignancies when used with cystoscopy, according to a report in the January 18 issue of the Journal of the American Medical Association (JAMA).
The lead author, H. Barton Grossman M.D. at the M. D. Anderson Cancer Center stated, “This study confirms the prior BladderChek investigation published in JAMA early last year— NMP22 BladderChek combined with cystoscopy detects significantly more cancers than cystoscopy alone. Because bladder cancer has a very high recurrence rate, we need to monitor patients vigilantly. Adding the NMP22 test to routine monitoring provides an extra measure of confidence. This test has important advantages over other methods: it provides results while the patient is at the doctor’s office and as a molecular marker it can detect cancers that might be missed visually without requiring intact cells. No other test is FDA approved for both diagnosis and monitoring that can be used during a patient visit and costs less than cytology.”
When used in combination with cystoscopy, a visual examination of the bladder, the NMP22 BladderChek test detected 99% of bladder malignancies compared to 91% for cystoscopy alone.The BladderChek test was positive for 8 of 9 cancers not seen by cystoscopy, including seven tumors that were aggressive or advanced.The BladderChek test also detected four times as many cancers as the commonly used laboratory based urine cytology test.
The authors of the study, who include clinical investigators at the University of Texas M. D. Anderson Cancer Center, the University of Miami School of Medicine, the University of Rochester Medical Center, Rhode Island Hospital, and community based clinicians, recommended using the NMP22 BladderChek® Test in the routine monitoring and management of bladder cancer patients.They noted that it is an inexpensive and a cost-effective tool, proven to detect significantly more cancers than urine cytology, and at half the cost.When combined with cystoscopy the NMP22® test improves the detection of cancer. Unlike all cell-based urine tests it does not require laboratory time and facilities and expert analysis. This point-of-care test provides unambiguous results during a patient’s visit.
“NMP22® BladderChek® Test is an important tool for doctors—early detection of bladder cancers, both initial and recurrent, improves treatment options and patient outcome,” said Edward Messing M. D., Chairman of the Urology Department at the University of Rochester Medical Center. “Delay of diagnosis of an aggressive bladder cancer even by a few months can affect prognosis. The AUA guidelines for evaluation of patients with blood in the urine recommend using a urine test as back up to cystoscopy. We use the NMP22 test in our practice, and will include it in an upcoming National Cancer Institute (NCI) study for monitoring bladder cancer recurrence after treatment.”
Bladder cancer has the highest rate of recurrence of any malignancy, with the cancer recurring in 50% to 90% of patients, depending on the aggressiveness and extent of the initial tumor. Patients are rigorously monitored throughout their lives for new malignancies.A combination of methods is used to monitor patients since no single method is 100% accurate in detecting the cancer.
The prevalence of bladder cancer in the United States is higher than lung cancer; and its prevalence in women is similar to the number of women with cervical and ovarian cancers. Currently there are 500,000 Americans with a history of bladder cancer.
Developed and commercialized by Matritech (Amex: MZT), a leading developer of protein-based diagnostic products for the early detection of cancer, the NMP22 BladderChek Test is the only noninvasive point-of-care assay approved by the FDA as an aid in both the initial diagnosis and monitoring of bladder cancer.Using only four drops of urine, the test detects elevated levels of the nuclear matrix protein NMP22 and results are available during the patient visit.
“Bladder cancer is the second most common urologic malignancy in the U.S. after prostate cancer,” notes investigator and author Mark Soloway M.D., Chairman, Department of Urology at the University of Miami School of Medicine. “We have made dramatic changes with the use of PSA, an early detection program, and tremendous public awareness. Unfortunately, we have not done the same with bladder cancer. One quarter of all bladder malignancies are still first diagnosed after they have become invasive, so treatment is more difficult and prognosis is worse. This hasn’t changed in 20 years. The NMP22 BladderChek test is an important step forward. Not only has it been demonstrated in two large studies to improve detection of new and recurrent cancers, it provides an easy and inexpensive way for primary care doctors to screen patients we know are at higher risk for bladder cancer: people who smoke, are exposed to chemicals or have blood in their urine.”
Because of the high recurrence rate of bladder cancer, patients who have had the disease are typically evaluated for new tumors every three months for the first two years after surgery, twice a year for the next two years, and yearly after that, until a recurrence is diagnosed, at which point monitoring resumes at three month intervals.Early detection is key to extending and providing quality of life for patients, and reducing treatment costs.The five year survival rate is 94% for patients diagnosed with early stage, or noninvasive cancer, while patients with metastatic or advanced stages of the disease have as low as a 6% chance of surviving five years.
“I was diagnosed with bladder cancer ten years ago,” said Sylvia Ramsey, a professor at the Georgia Military Community College-Augusta, GA, and a leading bladder cancer patient advocate.“But, for a year, I was told I only had a bladder infection.Finally, I was referred to a urologist.”Professor Ramsey added, “Each day I am grateful that I am one of the lucky ones. Even though I am cancer free, it is a constant and vigilant process to make sure I stay that way. My urologist and I have a regular set of appointments to keep monitoring me.Ten years ago there was no BladderChek® Test. Today, what a difference! When I speak or write about bladder cancer, I urge people at risk for this cancer to be aware of its symptoms and ask their doctor about being tested.Now with the BladderChek Test, hopefully, the bladder infection that is really cancer will be found earlier.”
Bladder cancer has the highest cost per patient of all cancers from diagnosis to death, with estimated annual direct costs of bladder cancer management at $4 billion. Because of the frequent recurrences and need for rigorous monitoring, this cost per patient from diagnosis to death, ranges from $96,000 - $187,000. The average Medicare reimbursement for urine cytology is approximately $56, and $24 for the NMP22 point-of-care assay. Using these costs, the estimated savings to the medical system would be $16 million per year for one monitoring visit for each of the current 500,000 patients with a history of bladder cancer using the NMP22 test instead of cytology. Actual savings would be higher since people with a history of bladder cancer often have more than one monitoring evaluation annually.
The direct cost of treatment for patients with metastatic genitourinary cancer has been estimated to be more than six times greater than for those patients with localized disease for the same period of time. The challenge, therefore, is to improve detection of bladder cancer without increasing discomfort or cost to the patient.
Costs of detecting a case of bladder cancer using the BladderChek test have been estimated to be $2,625.This cost is comparable to accepted cancer screening tests such as mammography, PSA, and colonoscopy. For women undergoing mammography screening, the cost per breast cancer detected can be as high as $14,000. Prostate cancer screening with PSA leads to costs of nearly $3,000 per cancer detected; colorectal cancer screening has a broader range of $2,000-$5,000 per cancer detected.
About the Study
The study included 668 patients with a history of bladder cancer and was conducted at 23 clinical sites in nine states, including academic, private practice and veterans’ facilities.The study was designed to investigate whether the NMP22 point-of-care test could improve detection of recurrence of a bladder malignancy in the routine monitoring of patients with a prior history of bladder cancer.Patients provided a urine sample for analysis of NMP22 protein and cytology prior to cystoscopy. Testing for the NMP22 tumor marker was conducted in a blinded manner.
About the NMP22® BladderChek® Test
The NMP22® BladderChek® Test was developed and commercialized by Matritech, a leading developer of protein-based diagnostic products for the early detection of cancer.In June 2005 the Company announced that more than 600,000 BladderChek® Tests had been sold and Matritech expects to reach a cumulative one million units sold by early 2006.In May, 2005 the NMP22®
BladderChek® Test was featured in a number of platform presentations at the 100th annual meeting of the American Urological Association (AUA); these included clinical trial results and a cost impact analysis that demonstrated the costs of detecting a case of bladder cancer using the BladderChek® Test are similar or less than currently accepted cancer screening methods such as mammography, PSA, and colonoscopy.Additionally, the NMP22® BladderChek® Test was part of the curriculum in an AUA sponsored CME course on bladder cancer based on information presented at the annual meeting.
The NMP22® BladderChek® Test detects elevated levels of the NMP22 protein in a single urine sample. Most healthy individuals have very small amounts of the NMP22 protein in their urine, but bladder cancer patients commonly have elevated NMP22 protein levels, even at early stages of the disease. The NMP22® BladderChek® Test, a painless and non-invasive assay, is the only in-office test approved by the FDA for the diagnosis of bladder cancer. The BladderChek® Test, which is reimbursed by Medicare and other medical insurers, is more cost effective than cell-based laboratory cytology tests.It is approved for use in a physician’s office with results available during the patient visit, allowing a rapid, accurate and cost-effective way to aid in the detection of bladder cancer.NMP22® Tests have been approved by the FDA four times for two formats and claims, most recently in April 2003 for point-of-care use for diagnosis.
About Bladder Cancer
Bladder cancer is the fifth most common malignancy in the United States.There are over 500,000 people in the U.S. who have had bladder cancer, making it more prevalent in the population than lung and bronchial cancers.The American Cancer Society estimates that over 63,000 new cases of bladder cancer were diagnosed in the United States in 2005 (over 47,000 men and 16,000 women), and over 13,000 people died of the disease (nearly 9,000 men and 4,000 women). Worldwide it accounts for 330,000 new cases and 100,000 deaths each year. It is also one of the most chronic cancers, recurring in almost 70% of patients.The most common symptom of bladder cancer is blood in the urine, a condition referred to as hematuria.
Bladder cancer is diagnosed primarily in men age 60 and older (it does occur at younger ages) and roughly twice as frequently in white men as in black men.Men are three times more likely to be diagnosed with bladder cancer than women, but a greater percentage of women are diagnosed at an invasive stage of the malignancy.Among U.S. males, the incidence of new bladder cancer cases is almost as large as the incidence of colon cancer.
The most common risk factor for bladder cancer is smoking. Smokers are more than twice as likely to develop bladder cancer as nonsmokers. In the United States, smoking is estimated to be associated with about 50% of bladder cancer deaths among men and 30% among women.
Occupational exposures to chemicals (aromatic amines) used in dry cleaning facilities and the production of dyes, paper, rope, apparel, rubber and petroleum products have been associated with increased risk for bladder cancer. Other industrial exposures implicated as risk factors for developing bladder cancer include combustion gases and soot from coal, chlorinated aliphatic hydrocarbons, and chlorination by-products in heated water.
If diagnosed in its early stages, bladder cancer has a five-year survival rate of 94%. If diagnosed at an advanced stage, however, the five-year survival rate can be less than 10%.It has been estimated that this year in the United States about 25% of bladder cancer patients will be diagnosed after their disease has become invasive or metastatic, significantly lowering the five year survival rate.
Among U.S. women, according to the most recent SEER data, the prevalence of bladder cancer (140,000) is similar to the number of women with cervical (184,000) and ovarian (159,000) cancers.The five year survival rate of women is less than the ten year survival rate of men.Diagnosis in women may be delayed because symptoms are misinterpreted or attributed to other causes.This delay is correlated with a disproportionately higher death rate among women.In 2005 women accounted for one in four new bladder cancer diagnoses, but one in three bladder cancer deaths.
Over 63,000 new cases per year in the United States; over a
half million people in the U.S. have had the disease
worldwide it accounts for 330,000 new cases and 100,000 deaths each year
highest rate of recurrence of any cancer, including skin cancer; 50-90% recurrence within 6-12 months
3 times higher incidence in men than women
women have a higher mortality rate – the five year survival rate of women is less than the ten year survival rate of men
women account for 1 in 4 new diagnoses, but they account for 1 in 3 bladder cancer deaths
diagnosis in women may be delayed because symptoms are misinterpreted or attributed to other causes
firefighters are particularly “at-risk” –2 times the incidence than the general population
According to the National Cancer Institute, the prevalence of bladder cancer in the U.S. has surpassed that of lung cancer and:
among U.S. males, there are almost as many new cases as colon cancer
among U.S. women, the prevalence of bladder cancer (140,000) is similar to the number of women with cervical (184,000) and ovarian (159,000) cancers.
most common risk factor is smoking.Smokers are more than twice as likely to develop bladder cancer as nonsmokers. In the United States, smoking is estimated to be associated with about 50% of bladder cancer deaths among men and 30% among women.
occupational exposures to chemicals (aromatic amines) used in dry cleaning facilities and the production of dyes, paper, rope, apparel, rubber and petroleum products, combustion gases and soot from coal, chlorinated aliphatic hydrocarbons, and chlorination by-products in heated water have been associated with increased risk for bladder cancer
most common symptom is blood in the urine, a condition referred to as hematuria
when diagnosed in its early stages, a five-year survival rate of 94%
when diagnosed at an advanced stage, the five-year survival rate can be less than 10%
25% of patients are diagnosed after the disease has become invasive or metastatic
2nd most common urologic malignancy in the United States
5th most common cancer in the United States
4th leading cause of cancer in men
Most common in men over 65 years
More than 13,000 deaths per year
For more information on Bladder Cancer, Awarenness, and Support, visit the Bladder Cancer WebCafe at: www.blcwebcafe.org.
General information about signs and symptoms of Bladder Cancer: The symptom information on this page attempts to provide a list of some possible signs and symptoms of Bladder Cancer. This signs and symptom information for Bladder Cancer has been gathered from various sources, may not be fully accurate, and may not be the full list of Bladder Cancer signs or Bladder Cancer symptoms. Furthermore, signs and symptoms of Bladder Cancer may vary on an individual basis for each patient. Only your doctor can provide adequate diagnosis of any signs or symptoms and whether they are indeed Bladder Cancer symptoms.
List of symptoms of Bladder Cancer: The list of signs and symptoms mentioned in various sources for Bladder Cancer includes those listed below. Note that Bladder Cancer symptoms usually refers to various symptoms known to a patient, but the phrase Bladder Cancer signs may refer to those signs only noticable by a doctor:
Symptoms of Bladder Cancer: Common symptoms of bladder cancer include:
·Blood in the urine (making the urine slightly rusty to deep red),
·Pain during urination, and
·Frequent urination, or feeling the need to urinate without results.
These symptoms are not sure signs of bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the doctor can diagnose and treat any problem as early as possible. People with symptoms like these may see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system.1
Hello, I would like to welcome you to the BCSisterhood. I am bladder cancer survivor and because of it being stage III and invasive by the time it was diagnosed, my bladder was removed and I had to undergo a radical hysterectomy. I have an Indiana pouch. I consider myself very lucky to be alive almost 10 years later. I have been working on awareness and advocacy for several years. One thing I have discovered, as I am sure many of you have also, is that there is little out there directed to the support for women who have bladder cancer. There is little research that is directed to bladder cancer. The awareness of this cancer as it relates to women is very limited. Far too many doctors do not test women for bladder cancer even when they have all the symptoms and are in one of the risk groups. I hope this blog will be a way that we can unite and change that. If we bond together, speak out in a unified voice, we may begin to be heard. As least we can begin to make a difference for those that follow us. I hope that you will submit your pictures and your stories. It will help others to know they are not alone. They need you, and we need each other.