{"entity":{"id":"idea-prev-urine-dna-haematuria-triage","kind":"idea","name":"A urine DNA test to decide who with blood in the urine needs a camera test","aka":[],"tldr":"Most people referred for blood in the urine do not have bladder cancer, yet all get cystoscopy. A urine DNA or methylation test could safely spare most of them.","summary":"Most people referred with blood in the urine do not have bladder cancer, yet all undergo cystoscopy, so this idea uses a urinary DNA methylation or mutation test to decide who needs the camera test. Biomarker-negative patients would be randomised to deferred versus immediate cystoscopy, with missed muscle-invasive cancer as the safety endpoint and cystoscopies avoided as the efficacy endpoint. Cystoscopy capacity is a rate-limiting step for urology worldwide and urinary assays report high negative predictive value, so safe triage could spare most patients. The test is a 3,000-patient RCT with a pre-agreed non-inferiority margin. At early-clinical maturity it addresses the bottlenecks The hardest cancers are found late and Overdiagnosis and false alarms.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022)","url":"https://doi.org/10.1126/science.aay9040"}],"tags":[],"related":[],"cancers":["urothelial"],"sections":["early-detection","diagnostics"],"technologies":["liquid-biopsy","methylation-profiling"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["ppv"],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-overdiagnosis"],"keyPapers":["paper-crosby-science"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Biomarker triage reduces cystoscopies by at least half with a missed high-grade cancer rate below 0.5%.","rationale":"Bladder cancer prevalence in haematuria referrals is 5-10%; cystoscopy capacity is a rate-limiting step for urology worldwide.","test":"Run a 3,000-patient RCT with a pre-agreed non-inferiority margin.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":3},"route":"/ideas/idea-prev-urine-dna-haematuria-triage/","neighbours":{"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"}],"section":[{"id":"diagnostics","kind":"section","name":"Diagnostics & Biomarkers","route":"/fronts/diagnostics/"},{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"methylation-profiling","kind":"technology","name":"DNA methylation profiling","route":"/technologies/methylation-profiling/"},{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"urine-bladder-cancer-tests","kind":"technology","name":"Urine tests for bladder cancer (cytology, FISH, RNA and methylation)","route":"/technologies/urine-bladder-cancer-tests/"}],"term":[{"id":"ppv","kind":"term","name":"Positive predictive value (PPV)","route":"/terms/ppv/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-crosby-science","kind":"paper","name":"Early detection of cancer","route":"/key-papers/paper-crosby-science/"}]}}