The American College of Physicians has issued new recommendations for evaluating hematuria as a marker for occult urinary cancer.

The clinical guideline, published in the Annals of Internal Medicine,recommends the following:

Gross hematuria should be included in clinicians’ routine review of systems. In particular, all patients with microscopic hematuria should be asked about their history of visible hematuria.

In asymptomatic adults, screening urinalysis shouldn’t be used to detect cancer.
In asymptomatic patients, heme-positive results from dipstick tests should be confirmed with microscopic urinalysis demonstrating three or more erythrocytes per high-powered field.
All adults with visible hematuria, even if self-limited, should be referred for further urologic workup.
For adults with microscopically confirmed hematuria but no demonstrable benign cause, clinicians should consider a urology referral for cystoscopy and imaging.
Hematuria should be evaluated even if patients are taking antiplatelets or anticoagulants.
Urinary cytology or other urine-based molecular markers for detecting bladder cancer shouldn’t be ordered in patients’ initial evaluation for hematuria.