He refers to bladder cancer as “the forgotten carcinoma”: as a renowned urologist, Dr Robert Hefty focused his attention on bladder cancer from an early stage. No wonder, then, that he immediately got involved in the “Bladder Cancer Roadshow 2021” project, which aims to raise awareness of this type of cancer among the general public – including both specialists and GPs. So 20 September 2021 was an important date for the consultant and his team at the Department of Urology at Heidenheim Hospital, as the response was overwhelming. The Leading Medicine Guide spoke to Dr Hefty about this – and about the opportunities to continue raising awareness of bladder cancer in the future.
Leading Medicine Guide: When the bladder cancer roadshow toured Germany and Austria in the summer of 2021, you and the senior medical team from your clinic were one of the stops. How did that come about?
Dr Robert Hefty: Thanks to my training at Ulm University Hospital, where, incidentally, the first neobladder operation was performed (a continent urinary bladder substitute created from the small intestine – Ed.), I have been working on bladder cancer for a long time. Many people know me, and I know many others who are also deeply involved in this field, including internationally. I have many contacts in the USA and across Europe. Even Australia and Asian countries are on the up-and-coming side here.
Leading Medicine Guide: So you owe your involvement to your excellent network?
Dr Robert Hefty: In fact, I was approached directly by the organizers, Fa Photocure® and Wolf, as I have been working with them for years and I myself treat many bladder cancer patients. Unfortunately, compared to breast or bowel cancer, bladder cancer is completely neglected in Germany. In the Anglo-American world, entire ‘Bladder Awareness’ months are organized, during which the bladder receives a great deal of attention. We are a long way from that here in Germany. The main message should be to allay people’s fears of visiting a urologist, although many are unaware that urologists are not solely responsible for the prostate and do not only treat men.
Leading Medicine Guide: And how did the day go? There was a huge turnout. Were there many questions from the audience – and were you able to raise awareness in this way as a consultant?
Dr Robert Hefty: First of all, we had a perfect team comprising the roadshow staff and our urology team, who made the preparations together. We even had chocolates made to promote the roadshow. Because we were based right at the hospital, there was indeed a large turnout of genuinely interested people. We were able to inform people via a trail with various stations – covering risk factors, symptoms, diagnosis, treatment and so on. In addition, medical professionals demonstrated the latest urological equipment. Overall, the ‘Bladder Cancer Roadshow 2021’ in Heidenheim must be seen as an important foundation for further such events, because – as I said – people are simply not familiar with the subject.
Education is needed: Dr Robert Hefty in conversation during the “Bladder Cancer Roadshow”
Leading Medicine Guide: In Germany alone, up to 30,000 people are newly diagnosed with bladder cancer every year. Yet you describe this disease as “the forgotten carcinoma”. Isn’t that a misrepresentation?
Dr Robert Hefty: Because there is still too little information available and because many people downplay the problem of ‘blood in the urine’! Unfortunately, not even the Joint Federal Committee has a specific screening test for bladder cancer in its preventive care guidelines. We mustn’t forget that the GBA determines healthcare guidelines and thus decides which services are covered by statutory health insurance. After all, bladder cancer is the fourth most common tumor in men, and without treatment it is highly aggressive.
Leading Medicine Guide: The high-profile roadshow came at just the right time. Some time has now passed. How can we continue to raise awareness among the general public – and also among the medical profession?
Dr Robert Hefty: We actually had two patients who responded immediately. They presented with acute bladder bleeding. Diagnostic tests revealed tumors in the early stages in both cases. They were able to undergo surgery and were initially cured without losing their bladders completely.
Leading Medicine Guide: If the number of cases of bladder cancer is rising, particularly among men – how can this be countered? What should people do or avoid doing to prevent such a disease? In other words: what are the risk factors?
Dr Robert Hefty: The main risk factor is smoking, including former smokers – even if people have not smoked for twenty years, they have been exposed to the agent that triggers the cancer. Furthermore, bladder cancer is recognized as an occupational disease among workers in the textile dyeing industry, hairdressers and those in the leather processing sector. This means that bladder cancer also plays a role in public health.
Leading Medicine Guide: Although the disease is less common in women, it is more frequently only detected at an advanced stage. Why is that? Does it have anything to do with the symptoms?
Dr Robert Hefty: No. The main reason for this is that in women, bladder bleeding is often downplayed, interpreted as a urinary tract infection and therefore treated incorrectly. Furthermore, the crux of the matter is that female patients with recurrent infections are at risk of malignancy. In women, the issue of ‘blood in the urine’ is taken far too lightly. Women do not usually go straight to a urologist with their symptoms.
Leading Medicine Guide: During the roadshow in Heidenheim, you also placed great emphasis on an “exchange on equal terms”. Surely that’s also linked to the fact that you always approach your patients openly, isn’t it?
Dr Robert Hefty: Generally speaking, I am a very empathetic person and try to respond to all kinds of people. That is why we at Heidenheim Hospital draw up completely individual treatment plans. I attach great importance to this! We naturally follow the guidelines, but not just national ones, but international ones as well. So we always try to stay up to date – and to treat patients according to the standards of evidence-based medicine, meaning we always base our approach on the best data and sources available to us. In doing so, we utilize up-to-date, scientifically verified information and integrate it into our treatments. In this way, we offer ‘high-class urological medicine’ – truly top-class urology – backed by the best expertise.
Leading Medicine Guide: Dr Hefty, thank you very much for these insights into the current state of affairs regarding bladder cancer. Perhaps this interview can also help to draw attention to ‘the forgotten carcinoma’.
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