Bladder cancer in Africa is frequently associated with infection by the urinary trematode parasite, Schistosoma haematobium and has been the subject of several hospital-based studies. In fact, a recent review of the topic was unable only to quote any data on the epidemiology and associated risk factor analysis for bladder cancer in Africa. There is a need to establish the role of this condition in endemic areas, and to determine the nature and frequency of various risk factors so that public health authorities can formulate effective control strategies. Recent research has suggested that chronic inflammation due to chronic and repeated insults from microorganisms may increase oxidative stress damage in tissue resulting in genetic changes that set the stage for malignant transformation of tissue. Urinary schistosomiasis is a persistent infection of young people that becomes chronic as they age, providing a nidus in the urothelium, which may attract bacteria, viruses and other inflammation stimulants. These, in their plethora may be the source of the repeated insults that contribute to tissue hyperplasia. However, in order to establish the true public health importance of bladder cancer, it is necessary to collect epidemiological data from an endemic area. This can be done in Ghana where S. haematobium is prevalent. Using appropriate sampling procedures, within the limitation of a small grant, sufficient infected individuals can be examined with noninvasive techniques which will provide data on the prevalence and intensity of infection as well as on the existence of biomarkers of cancer and co-infections detected by urine examination. Ultrasound examination will provide evidence for lesions of the urothelium classified for magnitude. Finally where indicated, and with informed consent, invasive examination by collection of biopsy material may be necessary for verification of the nature of any lesion. Cytological examination of urine sediment and subsequent testing of tissue for proteomics analysis in later studies will provide information on the various insults occurring in the bladder and the extent of local inflammatory responses and their association with developing cancer. The study has the potential to be extended in order to consider the mechanism of genetic change and selection of oncogenes on an epidemiological basis, and to assess the frequencies with which these occur in people living in such endemic conditions.
| Koukounari, Artemis; Webster, Joanne P; Donnelly, Christl A et al. (2009) Sensitivities and specificities of diagnostic tests and infection prevalence of Schistosoma haematobium estimated from data on adults in villages northwest of Accra, Ghana. Am J Trop Med Hyg 80:435-41 |
| Naples, Jean; Isharwal, Sumit; Shiff, Clive J et al. (2009) Clinical utility of squamous and transitional nuclear structure alterations induced by Schistosoma haematobium in chronically infected adults with bladder damage verified by ultrasound in Ghana. Anal Quant Cytol Histol 31:143-52 |
| Shiff, Clive; Veltri, Robert; Naples, Jean et al. (2006) Ultrasound verification of bladder damage is associated with known biomarkers of bladder cancer in adults chronically infected with Schistosoma haematobium in Ghana. Trans R Soc Trop Med Hyg 100:847-54 |
