May is Bladder Cancer Awareness Month.

John Bordeaux
2 min readApr 30, 2019
Several close friends at sunset

Many people my age end up championing an awareness of specific cancers; suffice to say the choice is usually thrust upon us. So, to awareness:

It is the lifetime costliest cancer of them all, largely because it has the highest rate of recurrence.

Regular exams are required for the rest of your life, there is no cure. (Every 3 months, then 6, then annually.)The exams themselves (cystoscopies) are a costly procedure. If a tumor is found, you then schedule outpatient surgery with general anesthesia. Every single time.

The surgery is followed by one or more days wearing a catheter. There is a stylish leg bag available, should you run out of sick days. You then return to the urologist to have the catheter removed, and it’s on to the next exam. Following surgery, your course of action may be chemotherapy: injected, held, and voided. It may be immunotherapy, where an attenuated tuberculosis vaccine (BCG) is injected, held, and voided — every week for six weeks. These are intended to lower the risk of new tumors.

2019 marks 90 years of BCG use in treating cancers. 90 years. The regimen of 6 week treatments for bladder cancer was developed in 1976, because, and this is true: the BCG arrived at the lab in six-packs. Make your own jokes here.

Lifetime exams and removal may be your outcome. Possible other outcomes include the removal of all or part of your bladder, your prostate should you bring one to this party, and a few lymph nodes. A lifetime urostomy bag follows.

The fun part: There is now a global shortage of BCG, as it is used primarily as a TB vaccine (outside the U.S.). There is one producer and it is not highly profitable — so the invisible hand of the market speaks. People with high-grade tumors who need BCG are being rationed and costs are rising. The manufacturer is increasing production, but so far it is not enough. Bladder cancer patients are living with 90-year old solutions refined last in 1976, if they can access them.

If you have blood in your urine, it may be a kidney stone causing mischief. It may be an infection. But it may also be cancer. One that brings with it a costly lifetime relationship, if you’re lucky. Learn more:

Disclaimer: I am a Dr, but “not the kind that helps people.” Check my facts, check the literature, consult your urologist if you have questions or concerns.