It is -- in the words of many patients -- a "hideous disease" yet most people are unaware of it even though it will strike one of every 42 Americans. .

Each year, it kills over 15,000 Americans and strikes another 72,000.

Bladder cancer has the highest recurrence rate -- a daunting 50 to 80 percent -- and mandates lifetime monitoring as well as expensive treatments that many people can't endure. And it's the most expensive to treat on a per-patient basis -- $100,000 to $200,000 (based on 2003 values.)

In the U.S., bladder cancer costs a staggering $3 billion annually.

In two decades of treating bladder cancer as a urologic surgeon and researcher, I've seen success and tragedy. But in all cases, after diagnosis, life is never the same.

May is national Bladder Cancer Awareness Month. My fellow urologists and our patients believe the time is now for the U.S. to increase funding to educate the public to recognize and lower their risk and make a cure for bladder cancer a priority.

There have been no significant treatment advances in this disease in more than two decades. The "gold standard" for early stage remains "BCG" (a weakened form of live cow tuberculosis) and it too is decades old.

Treatments and their side effects challenge any patient's fortitude. One involves injecting weakened tuberculosis or some of the world's strongest chemotherapy agents via a catheter into the bladder (particularly loathsome for men) where it must be held for two hours and repeated for at least six weeks.

Side effects can include severe stinging during urination or urinating dozens of times daily-- to name a few. Such treatment can even eventually cripple the bladder. When surgeons can't preserve a cancerous bladder, they can sometimes replace it with a reservoir formed from the patient's bowel (neo-bladder). But recovery is six weeks to one year. Bladder cancer surgery can also entail removal of other organs such as kidneys, lymph nodes and prostate (in men).

Bladder cancer's share of federal funding is dismal -- less than 20th -- for a disease that 500,000 Americans currently live with.

More funding could boost promising new treatments including immunotherapy clinical trials, novel chemotherapy delivery and "gene therapy" as well as unlock genetic mysteries and spawn therapies for other cancers.

What should be done?

  • Support the Bladder Cancer Advocacy Network (BCAN.org). Contributions are tax deductible.

  • Urge Congress to increase funding via the National Institutes of Health (NIH) and National Cancer Institute for large research institutions including universities.

  • Encourage Public Service Announcements or commercials similar to powerful anti-smoking ads to raise awareness of symptoms -- blood in urine, uncomfortable or frequent urination for example.

  • Urge medical institutions to increase clinical trial access.

  • Stop or never start smoking, which has a stronger link to bladder cancer than it does to lung cancer!

  • Educate the media.

  • Increased funding could benefit all stakeholders: bladder cancer victims and their families, the U.S. health care system and potentially all cancer patients.

    Michael O'Donnell, M.D, F.A.C.S., is a professor and director of urologic oncology at the University of Iowa Carver College of Medicine in Iowa City, Iowa. He is a member of the BCAN Scientific Advisory Board.