Bladder cancer is the seventh most common cancer worldwide in men and the 17th in women with an overall number of 356,000 new cases of urinary bladder cancer worldwide in 2002. It is one of the most expensive cancers from diagnosis to death and the fifth most expensive cancer in terms of total medical care expenditures in the US. A screening program that resulted in detection of bladder cancer at an earlier stage, prior to muscle invasion or metastasis, could render a significant improvement in patient morbidity and overall survival. Acceptance of wide-spread screening strategies requires careful consideration of the competing risks, benefits, and costs associated with such policies. In this article, we will review the pros and cons of bladder cancer screening with a focus on cost-effectiveness and who should be screened.