Objective:
To describe the management of patients with hematuria in the Nordic
countries in relation to bladder cancer epidemiology, especially in the
context of introducing fast track pathways with the aim of proposing a
common guideline.

Materials and methods:
Epidemiological data on bladder cancer from each country, and the
combined cancer registry, Nordcan, were analyzed. The evolution of the
different national recommendations and the introduction of fast track
pathways were assessed. Patients' demographics, type of hematuria and
cancer detection rates were analysed if available.

Results:
The crude incidence of bladder cancer has increased substantially since
the 1960s, while the age standardized incidence has been stable during
recent decades. The relative survival has increased in all countries,
while the mortality has been stable. For those with microscopic
hematuria there has been a clear trend towards less rigorous
investigations. In the fast track pathways, introduced in three of five
countries, about one in five patients with macroscopic hematuria had a
cancer diagnosis. Data show that time to diagnosis has been reduced.

Conclusions:
The number of patients with bladder cancer is increasing in the Nordic
region. The introduction of fast track pathways has been important in
improving the management of patients with suspicion of the disease. Our
recommendation is to focus on macroscopic hematuria in the fast track
pathways. Microhematuria without any symptoms should not be an
indication for cystoscopy. However, urinary tract symptoms accompanied
by microhematuria can still be investigated according to respective
guidelines but not necessarily within fast track pathways.