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Screening for Hematuria-Reply

Richard J. Pels, MD; Steffie Woolhandler, MD, MPH; Robert S. Lawrence, MD; David H. Bor, MD; David U. Himmelstein, MD
JAMA. 1990;263(13):1764. doi:10.1001/jama.1990.03440130043013.
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In Reply.—  Both correspondents seem confident that dipstick screening for hematuria will do more good than harm. Dr Lambird's analysis of costs and benefits is based on several unwarranted assumptions. His estimates of the rates of positive screening tests and the likelihood of disease among those who screen positive apparently are derived by summing the five studies listed in Table 1 of our original article. This approach gives undue weight to two large studies that included predominantly young male military recruits with very low rates of hematuria. Hence, he markedly understates the morbidity and cost associated with unnecessary workups. Similarly, he ignores potential ill effects from radiation exposure, the equivalent of about 15 chest roentgenograms per intravenous pyelogram. Finally, his estimates of increased cure rates due to early detection are purely speculative. Overall, the predominance of evidence suggests that in those younger than age 60 years, dipstick testing for hematuria

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