Olfactory detection of human bladder cancer by dogs: proof of principle study

doi:10.1136/bmj.329.7468.712

BMJ 2004;329:712 (25 September), doi:10.1136/bmj.329.7468.712

Paper

Olfactory detection of human bladder cancer by dogs: proof of principle study

Carolyn M Willis, senior research scientist¹, Susannah M Church, honorary research fellow¹, Claire M Guest, operations director², W Andrew Cook, deputy chief executive², Noel McCarthy, medical statistician³, Anthea J Bransbury, associate specialist¹, Martin R T Church, honorary research fellow¹, John C T Church, honorary consultant¹

¹ Department of Dermatology, Amersham Hospital, Amersham HP7 0JD, ² Hearing Dogs for Deaf People, Saunderton, Princes Risborough HP27 9NS, ³ Centre for Statistics in Medicine, Institute of Health Sciences, Oxford OX3 7LF

Correspondence to: C M Willis carolyn.willis{at}sbucks.nhs.uk

Objective To determine whether dogs can be trained to identifypeople with bladder cancer on the basis of urine odour moresuccessfully than would be expected by chance alone.

Design Experimental, "proof of principle" study in which sixdogs were trained to discriminate between urine from patientswith bladder cancer and urine from diseased and healthy controlsand then evaluated in tests requiring the selection of one bladdercancer urine sample from six controls.

Participants 36 male and female patients (age range 48-90 years)presenting with new or recurrent transitional cell carcinomaof the bladder (27 samples used for training; 9 used for formaltesting); 108 male and female controls (diseased and healthy,age range 18-85 years—54 samples used in training; 54used for testing).

Main outcome measure Mean proportion of successes per dog achievedduring evaluation, compared with an expected value of 1 in 7(14%).

Results Taken as a group, the dogs correctly selected urinefrom patients with bladder cancer on 22 out of 54 occasions.This gave a mean success rate of 41% (95% confidence intervals23% to 58% under assumptions of normality, 26% to 52% usingbootstrap methods), compared with 14% expected by chance alone.Multivariate analysis suggested that the dogs' capacity to recognisea characteristic bladder cancer odour was independent of otherchemical aspects of the urine detectable by urinalysis.

Conclusions Dogs can be trained to distinguish patients withbladder cancer on the basis of urine odour more successfullythan would be expected by chance alone. This suggests that tumourrelated volatile compounds are present in urine, imparting acharacteristic odour signature distinct from those associatedwith secondary effects of the tumour, such as bleeding, inflammation,and infection.

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Rapid Responses:

Read all Rapid Responses

Dog credentials: Herbert S. Skovronek, Ph. D.
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That'll do: David J. Wlody
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Hearty congratulations: Hywel C Williams
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Non-independence of observations: Thomas R Knapp
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Dogs should be kept on a lead.: Phillip J. Colquitt
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Canine olfactory detection of pregnancy too.: Rachel G Pryke
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It may be earlier than urine: Adrian White
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Good study: Avinash Manohar
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Was the trial blind?: James T Teo, et al.
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Cause or association?: Michael Leahy
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Smoking is not a confounder of the association between bladder cancer and selection of urines by dogs: Carolyn M Willis, et al.
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Points of clarification by the authors: Carolyn M Willis, et al.
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