My mom is 55 yo heavy smoker with no fhx of bladder cancer.on routine ua her rbcs 300 pus150. + blood and nitrite, no symtoms, risk of ca?next step

Her doctors office: Sounds more like a urinary tract infection, and they do not always cause symptoms. The doctor who ordered the urinalysis is responsible for telling you their interpretation and recommending treatment. If you have concerns and want a second opinion, a urologist would be the appropriate specialist to see. Stopping smoking would reduce her risk of all associated cancers, including bladder.

See a urologist: While this may be inflammatory, the lack of symptoms is concerning. Any bacterial presence should be treated based on a culture and careful followup pursued. If blood persists, imaging with contrast-enhanced ct scan and cystoscopy is necessary. Smoking (not family history) is a major risk factor for bladder cancer. In other words, smokers over 50 need to be carefully evaluated for hematuria.