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Haematuria: study casts doubt on NICE referral guideline

New findings from the DETECT I study question current National Institute for Health and Care Excellence (NICE) referral guidance on referring patient with haematuria for oncological assessment.

In 2015, NICE recommended that patients aged ≥45 years with visible haematuria (VH) and those aged ≥60 years with non-visible haematuria (NVH) plus either dysuria or raised serum white cell count should be urgently referred on a suspected cancer pathway. However, findings from the prospective multicentre DETECT I study make a case for investigation of all patients with VH.

The study recruited 3556 patients referred for investigation of haematuria at 40 hospitals between March 2016 and June 2017. In total, 602 patients (16.9%) were referred below the NICE-recommended age threshold for VH or NVH. In this group, cancer was diagnosis in 1.8%. No cancers were diagnosed in NVH less than 35 years of age. The incidence of cancer was 3.5% in patients with VH who were <45 years old and 1.0% in patients with NVH who were <60 years old.

Analysis of bladder cancers detected below the NICE age threshold for investigation of VH showed that 4 of 6 bladder cancers identified were high- or intermediate-risk cancers, one of which was muscle-invasive bladder cancer. Of the 4 bladder cancers detected in patients with NVH below the NICE age threshold, 3 were high- or intermediate-risk cancers, one of which was a G3pT1 case.

Presenting the findings in European Urology, the authors say the study suggests that patients with VH should be investigated regardless of age. They also call for European-wide guidelines on the referral of patients with haematuria for oncological investigation.


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