# A urine DNA test to decide who with blood in the urine needs a camera test

Source: https://onco.cc/ideas/idea-prev-urine-dna-haematuria-triage/  
OnCo record `idea-prev-urine-dna-haematuria-triage` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: Run a 3,000-patient RCT with a pre-agreed non-inferiority margin.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022): https://doi.org/10.1126/science.aay9040

## Connected records

- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [DNA methylation profiling](https://onco.cc/technologies/methylation-profiling/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Urine tests for bladder cancer (cytology, FISH, RNA and methylation)](https://onco.cc/technologies/urine-bladder-cancer-tests/)
- terms: [Positive predictive value (PPV)](https://onco.cc/terms/ppv/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- key papers: [Early detection of cancer](https://onco.cc/key-papers/paper-crosby-science/)

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