Bladder cancer screening: who is tested, and why blood in the urine is followed up

There is no standard screening test for bladder cancer in people at average risk. (NCI PDQ, patient) Blood in the urine is usually caused by something other than cancer, but it can be the first sign of bladder cancer, so it is important to have it checked by a doctor. (ACS, early detection)

Who is screened

Adults without symptoms: the USPSTF concludes the current evidence is insufficient to assess the balance of benefits and harms of screening for bladder cancer in adults without symptoms (I statement, 2011). A July 2024 literature scan found a lack of new evidence to support an updated review. (USPSTF, 2011)
People at average risk: ACS says major professional organizations do not recommend routine screening for most people, because screening has not been shown to lower the risk of dying from bladder cancer in people at average risk. (ACS, early detection)
People at high risk: ACS says some doctors may recommend screening for people with factors that strongly increase their risk, such as having had bladder cancer before, certain birth defects of the bladder, or exposure to certain chemicals at work. Screening might help some of them, but this has not been proven in large studies. (ACS, early detection)
Evidence: NCI says there is inadequate evidence to determine whether screening for bladder and other urothelial cancers has an impact on deaths, and, based on fair evidence, that screening would result in unnecessary diagnostic procedures with attendant harms. (NCI PDQ, 2025)

Higher-risk groups

Smoking: people who smoke are at least 3 times as likely to get bladder cancer as people who do not, and smoking causes about half of all bladder cancers. (ACS, risk factors)
Chemicals at work: industries carrying higher risks include makers of rubber, leather, textiles and paint products, as well as printing companies. Other workers with an increased risk include painters, machinists, printers, firefighters, hairdressers and truck drivers. Smoking and workplace exposures can act together, so people who smoke and also work with cancer-causing chemicals have an especially high risk. (ACS, risk factors)
Age and sex: about 9 out of 10 people with bladder cancer are older than 55, and bladder cancer is more common in men than in women. (ACS, risk factors)
Other factors the USPSTF lists: White race, infections caused by certain bladder parasites, and a family or personal history of bladder cancer. (USPSTF, 2011)

For other screenings linked to smoking, see screenings if you smoke.

The tests

The USPSTF says screening tests that can be done in primary care include a urine dipstick or microscopic urinalysis for blood, urine cytology, and urine biomarker tests. People with positive results are typically referred to a urologist, and further evaluation may include cystoscopy (and biopsy if a tumor is found), imaging, and other studies. (USPSTF, 2011)

Tests that may be used to look for bladder cancer, what each looks for, and what the sources say about it as a screening test
Test	What it looks for	As a screening test
Urinalysis (dipstick or microscope)	Blood in the urine (hematuria), checked with a test strip or under a microscope; the test may be repeated over time.	ACS: it can help find some bladder cancers early, but has not been shown to be useful as a routine screening test. (NCI PDQ, patient) (ACS, early detection)
Urine cytology	Abnormal or cancer cells in a urine sample, looked at under a microscope.	ACS: it can find some bladder cancers, but is not reliable enough to make a good screening test. (NCI PDQ, patient) (ACS, early detection)
Urine tumor marker (biomarker) tests	Substances in the urine made by bladder cancer cells or by the body in response to bladder cancer.	ACS: they might find some bladder cancers early but can miss some, and can be abnormal in people who do not have cancer; they are used mainly for people with signs or symptoms, or to watch for cancer coming back. (NCI PDQ, patient) (ACS, early detection)
Cystoscopy	A thin, lighted tube (cystoscope) passed through the urethra into the bladder to look for abnormal areas; tissue samples may be taken for biopsy.	NCI lists it among tests that may be used for people who had bladder cancer before or who are at increased risk. (NCI PDQ, patient)

Harms of screening include false-positive results, which can cause anxiety and are usually followed by more tests, such as cystoscopy, that also have risks. False positives often occur with hematuria testing, because blood in the urine is usually caused by conditions other than cancer. A false-negative result may lead someone to delay seeking care even if they have symptoms. (NCI PDQ, patient)

If blood is found in your urine

Blood in the urine is called hematuria. Gross hematuria is blood you can see; microscopic hematuria cannot be seen, but shows up under a microscope or on a urinalysis. (NIDDK) Your provider may find a small amount while checking your urine during a routine exam. (MedlinePlus, bloody urine)

Many possible causes: these include infection of the bladder, kidney, prostate or urethra, kidney or bladder stones, kidney failure, injury to the bladder or kidney, a recent urinary tract procedure, and cancer of the bladder or kidney. Blood that seems to be in the urine may also come from the vagina, from ejaculation, or from a bowel movement, and some medicines and foods such as beets can turn urine red. (MedlinePlus, bloody urine)
How it is defined: the AUA/SUFU guideline defines microhematuria as 3 or more red blood cells per high power field on a microscope check of a single urine sample. When a gynecologic or non-cancer urinary cause is found, it says the urinalysis should be repeated after that cause has resolved. (AUA/SUFU, 2020)
Risk groups: the guideline sorts people with microhematuria into low, intermediate or high risk for a urinary tract cancer, based on factors including age, sex, smoking and other urothelial cancer risk factors, how much blood is found and whether it persists, and any earlier visible blood. Cystoscopy and imaging of the upper urinary tract are recommended according to that risk, with shared decision-making. (AUA/SUFU, 2020) Its 2025 update revised the risk groups, updated information on urine tumor markers and cytology, and added new guidance on diagnosis and follow-up. (AUA/SUFU, 2025)
Possible tests: MedlinePlus lists tests that may be done for blood in the urine, including a urinalysis, urine culture, urinary cytology, blood tests such as creatinine and a complete blood count, an abdominal ultrasound or CT scan, and cystoscopy. (MedlinePlus, bloody urine)

For what the other parts of a urine test mean, see urinalysis results.

What a cystoscopy involves

The procedure takes about 5 to 20 minutes. The urethra is cleansed and a numbing medicine is applied inside it, without needles. The scope is passed through the urethra into the bladder, and water or salt water fills the bladder so the whole wall can be seen. If any tissue looks abnormal, a small sample can be taken for biopsy. You may feel discomfort and a strong need to urinate, and afterwards you may have blood in the urine and burning when urinating for a day or two. (MedlinePlus, cystoscopy) An abnormal result can point to bladder cancer, but also to other findings such as bladder stones, long-term urethritis or cystitis, scarring of the urethra, polyps or prostate problems. (MedlinePlus, cystoscopy)

Signs to report

ACS says blood in the urine is most often the first sign of bladder cancer, and it may come and go. Changes such as going more often than usual, pain or burning, urgency, a weak stream or getting up many times at night are more likely to have other causes, such as a urinary tract infection, bladder stones, an overactive bladder or an enlarged prostate, but should still be checked by a doctor. (ACS, signs)

MedlinePlus, when to contact a medical professional. Contact your provider if you have blood in your urine or other symptoms of bladder cancer, including: (MedlinePlus, bladder cancer)

Frequent urination
Painful urination
Urgent need to urinate

MedlinePlus, blood in the urine, when to contact a medical professional: (MedlinePlus, bloody urine)

You may not see blood in your urine because it is a small amount. This is called microscopic hematuria. Your provider may find it while checking your urine during a routine exam.

Never ignore blood you see in your urine. Get checked by your provider, especially if you also have:

Discomfort with urination
Frequent urination
Unexplained weight loss
Urgent urination

Contact your provider right away if:

You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back
You are unable to urinate
You are passing blood clots in your urine

Also contact your provider if:

You have pain with sexual intercourse or heavy menstrual bleeding. This may be due to a problem related to your reproductive system.
You have urinary dribbling, nighttime urination, or difficulty starting your urine flow. This may be from a prostate problem.

Where they differ:

USPSTF (US, 2011): evidence insufficient for adults without symptoms (I statement), listed as no recommendation. (USPSTF, 2011)
UK NSC (UK, 2026): screening is not recommended, because there is no safe, precise and valid screening test for bladder cancer. (UK NSC)
ACS (US): no routine screening for people at average risk, but some doctors may recommend it for people at high risk, such as people exposed to certain chemicals at work. (ACS, early detection)
NICE (UK, referral for symptoms, not screening): refer people for suspected bladder cancer if they are 45 or over with unexplained visible blood in the urine without a urinary tract infection, or visible blood that persists or comes back after successful treatment of an infection; or 60 or over with unexplained non-visible blood and either dysuria (painful urination) or a raised white cell count on a blood test. Consider a non-urgent referral at 60 or over for recurrent or persistent unexplained urinary tract infection. (NICE NG12)
AUA/SUFU (US, blood found on a urine test): testing is based on a low, intermediate or high risk group that uses age, sex, smoking and other factors. (AUA/SUFU, 2020) (AUA/SUFU, 2025)

Your doctor decides what your result means for you.

This page does not give treatment advice. If you have an abnormal result, see after an abnormal screening result for questions to ask.

Questions people ask

Should adults without symptoms be screened for bladder cancer?

Major groups do not recommend it. The USPSTF found the evidence insufficient to weigh the benefits and harms of screening adults without symptoms (I statement), and notes that no major organization recommends screening. The UK National Screening Committee does not recommend screening because there is no safe, precise and valid screening test. (USPSTF, 2011) (UK NSC)

Does blood in my urine mean I have bladder cancer?

Most often, no. ACS says blood in the urine is more likely to be due to something else, like an infection, a benign tumor, a stone in the kidney or bladder, or some other benign kidney disease. It is still important to have it checked by a doctor so the cause can be found. (ACS, signs)

Why is blood found on a routine urine test followed up?

Blood in the urine can be the first sign of bladder cancer, even though it is usually caused by other problems. The AUA/SUFU guideline sorts people with microhematuria into low, intermediate and high risk for a urinary tract cancer, based on factors such as age, sex, smoking and how much and how long the blood is found, and bases further testing on that risk. (ACS, early detection) (AUA/SUFU, 2020) (AUA/SUFU, 2025)

Who is at higher risk of bladder cancer?

ACS says people who smoke are at least 3 times as likely to get bladder cancer as people who do not, and that workers exposed to certain chemicals, such as in the rubber, leather, textile, paint and printing industries, have a higher risk. Risk also rises with age, and bladder cancer is more common in men. (ACS, risk factors)

What is a cystoscopy like?

MedlinePlus says it takes about 5 to 20 minutes. A numbing medicine is put inside the urethra, the scope is passed into the bladder, and fluid fills the bladder so the whole wall can be seen. You may feel discomfort and a strong need to urinate, and the urethra may be sore for a day or two afterwards. (MedlinePlus, cystoscopy)