This industry-based retrospective cohort study showed an increased risk neither for cancer of all sites nor site-specific cancers in relation to the shift work under study. Explicit characterization of shift schedules merits more consideration with respect to circadian disruption in future studies.Affiliation: BASF SE, GUA / CS -H306,

UroVysion in combination with NMP22 detected more cases than cytology alone, at the expense of a lower specificity. High costs per detected case resulted from a lower BC incidence than in the past when levels of occupational exposure to aromatic amines were higher. Currently, it cannot be recommended to apply these markers for screening in asymptomatic workers. The increase in sensitivity is not balanced by the high costs of UroVysion and the false-positive tests of NMP22.

What ' s known on the subject? and What does the study add?The prognosis of bladder cancer signifi cantly depends on tumour stage and time of diagnosis so early diagnosis is desirable to decrease mortality and treatment costs. The NMP22 test is approved for clinical application by the Food and Drug Administration (FDA) of the US. Previous studies have reported values of 47 -100% for sensitivity and 58 -91% for specifi city with this test, but there is no new data on the predictive value of NMP22 for screening bladder cancer (BC). The most important risk factor for BC is the tobacco consumption but occupational exposure to carcinogenic substances, especially aromatic amines, is regarded as another risk factor.The UroScreen study is a prospective longitudinal study for the early detection of BC. To our knowledge, it is the largest prospective validation study conducted over the longest period of time. The study results led us to conclude that, based on the currently available data, NMP22 should not be regarded as an alternative to endoscopy, and we could not make a general recommendation for screening or follow-up. The UroScreen results indicate that urine-based molecular markers could be a suitable addition to urine cytology and the detection of microhaematuria. OBJECTIVE• To evaluate the value of nuclear matrix protein-22 (NMP22) in bladder cancer (BC) screening, and its effect on variables in a prospective study in a high-risk population. PATIENTS AND METHODS• A total of 1772 chemical workers (mean age 62 years) exposed to carcinogenic aromatic amines were enrolled in the study.• In all, 7091 screening check-ups in 1609 subjects were performed.• Urine samples were collected for a quantitative NMP22 immunoassay, urine analysis and creatinine concentration assessment.• Cystoscopy and subsequent transurethral resection were performed where there were suspicious fi ndings. RESULTS• Histopathological analysis found three papillary urothelial neoplasms of low malignant potential, fi ve recurrent BCs and 13 primary BCs. Three tumours were at a muscle-invasive stage (pT2, pT3a or pT3b).• We found higher NMP22 concentrations ( > 10 U/mL) in 224 patients, which correctly predicted BC in six cases (sensitivity 97.29%, specifi city 28.57%; negative predictive value 99.04%, positive predictive value 12.24%).• Gross haematuria affected NMP22 results (odd ratio [ OR ] 3.49, 95% confi dence interval [ CI ] 1.81 -6.73). Infection also affected NMP22 results (OR 4.13,).• NMP22 was more frequently positive in urine with creatinine concentration > 2.5 g/L (OR 1.61, 95% CI 0.91 -2.86). CONCLUSIONS• NMP22 outcomes are affected by haematuria, infection and concentrated urine.• NMP22 alone cannot be recommended for primary screening in a high-risk population nor as an alternative to cystoscopy during follow-up.• A NMP22 test might be a useful adjunct to urine cytology. KEYWORDSbladder cancer , early detection , renal function , NMP22 , haematuria Study Type -Diagnostic (non-consecutive cohort without consistently applied reference st...

While there is presently no evidence-based foundation for "nano-specific" occupational medical screening, one can perform general medical screening with methods targeted at some of the health outcomes under discussion. The results of such examinations can provide a basis for future epidemiologic studies. Therefore, the establishment of exposure registries to enable the conduct of large-scale multi-centric prospective epidemiologic studies is recommended.

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RESULTS• As of July 2010, 15 bladder tumours were detected in 14 participants.• GH was found in four out of nine highgrade tumours and associated with a rate ratio of 3.82, 95% confidence interval (CI) 0.50-29.15 for the development of bladder lesions.• The PPV of GH was 11.4%, but only 1.2% for μ H. μ H occurred in 18.8% of urine samples and was not associated with bladder cancer [rate ratio (RR) 0.72, 95% CI 0.11-4.78].• Abundant urinary leukocytes were associated with μ H [odds ratio (OR) CONCLUSION• While the PPV of μ H for bladder cancer was low, there was a strong influence of haematuria and leukocytes on the proteinbased tumour test NMP22®.• Erythrocytes and leukocytes should be determined at least semi-quantitatively for the interpretation of positive NMP22 test results.• In addition, a panel of tumour tests that includes methods not affected by the presence of erythrocytes or leukocytes such as cytology and UroVysion TM would improve bladder cancer screening.

Corporate health promotion interventions to reduce the impact of BP and stress perception on work ability should target both physical and psychological dimensions. Such interventions may be initiated in the context of regular (occupational) medical examinations.

The present analysis extends and confirms our previous finding of no excess risk of mortality associated with work in the shift system employed at BASF Ludwigshafen. More specifically, there is also no indication of an increased risk of mortality due to cancer.