Managing asymptomatic workers at high risk of bladder cancer is discussed. Of the known risk factors, occupation carries the greatest risk for bladder cancer. Many groups of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of these workers have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer, approximately 20 years, that occurs prior to clinical manifestation of the disease. There is a need for defining what constitutes optimal management for asymptomatic workers. It is noted that most workers at high risk for bladder cancer receive no screening and most do not even know of their high risk status. Epidemiologic aspects of bladder cancer are summarized. The pathology of bladder cancer is discussed. Biochemical and immunologic markers for bladder cancer are reviewed. Recent studies have shown that abnormal chromosomes are indicative of increased bladder cancer recurrence. Two technological approaches for quantitating DNA content that allow for objective and repeatable examination of exfoliated bladder epithelial cells have been developed. These are flow cytometry and quantitative fluorescence image analysis. The treatment of bladder cancer is discussed. The authors conclude that a unified strategy for evaluating and implementing the most promising and effective means of bladder cancer control for high risk workers is needed.
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