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Screening and Detection

Microsatellite analysis of urinary sediment (MAUS) testing development consists of a urine test that screens for either early detection or recurrence of bladder cancer.

MAUS uses molecular biology to diagnose bladder cancer. The bladder cancer research effort at the Johns Hopkins Medical Institutions has been grounded in clinical and translational research for over 50 years. In the late 1940s, Drs. Jewett and Strong conceived the first staging system for superficial and invasive bladder cancer at Johns Hopkins, which is still used today.

Submucosal InfiltrationNo. of cases 3
Metastases 0
Perivesical lymph only 0
Perivesical fixation only 0
Potentially curable 100%
Muscular InfiltrationNo. of cases 15
Metastases 1
Perivesical lymph only 1
Perivesical fixation only 0
Potentially curable 86.6%
Perivesical InfiltrationNo. of cases 89
Metastases 52
Perivesical lymph only 6
Perivesical fixation only 8
Potentially curable 26%

Recent efforts in bladder cancer research have focused on finding the molecular origins of the disease. This important research conducted in the laboratory of Dr. David Sidransky, bladder cancer research member and university professor, has focused on understanding the relationship between genetic alterations in the bladder cancer cell and a tumor's ability to recur and progress.

Multiple publications have shown that alterations of specific genes on chromosome 9 probably contribute to the development of most bladder cancers. Detailed molecular maps of bladder cancers have been constructed in the laboratory and provide preliminary work for understanding how bladder tumors arise and recur.

These observations have led Dr. Sidransky's group to the novel application of specific molecular analytic laboratory techniques to diagnose bladder cancers. Specific types of molecular abnormalities can be identified in the urine of bladder cancer patients utilizing a new diagnostic bladder cancer test developed in Dr. Sidransky's laboratory. This test, called microsatellite analysis, is a very sensitive and accurate identifier of bladder cancer cells in voided urine. Pilot studies have already demonstrated that this test can correctly diagnose bladder cancer in greater than 90 percent of patients six months earlier than conventional diagnostic testing. Ongoing studies will help define the clinical role of this new test for bladder cancer detection and prevention.

Industrial monitoring program is a cancer detection program that uses the microsatellite urine test to monitor individuals who have been occupationally exposed to chemicals that are linked to bladder cancer.

Exposure to chemical carcinogens significantly increases one’s risk for developing bladder cancer. Approximately one fourth to one third of all cases of bladder cancer are believed to be caused by occupational exposure (Catalona, 1991). Those individuals at greatest risk include textile workers, painters, leather and metal workers and workers in the rubber industries (Brettschneider and Orihuela, 1990). All of these occupations carry a high risk of exposure to chemical carcinogens.

The Johns Hopkins Bladder Cancer Research Center has established a surveillance program that provides periodic screening for bladder cancer. One current industrial monitoring research protocol provides for yearly screening utilizing microsatellite analysis and cytology of voided urine in a high-risk population of workers exposed to a pesticide.

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