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Delay in Diagnosis of Bladder Cancer Longer in Women than Men

Reuters Health • The Doctor's Channel Newscast

NEW YORK (Reuters Health) – A diagnosis of bladder cancer after an initial presentation with hematuria is often delayed in both men and women – but the delay is significantly longer in women, a US team reports.

“This may be partly responsible for the sex-based discrepancy in outcomes associated with bladder cancer,” the researchers suggest in their report in Cancer online November 12.

Dr. Joshua A. Cohn, at the University of Chicago, Illinois, and colleagues note that relative to the incidence of bladder cancer, mortality is higher in women than men.  Differing delays in treatment may be one reason for the disparity.

To investigate the time from presentation of hematuria to diagnosis of bladder cancer, the team conducted a retrospective study of data from over 100 health insurance programs on more than 40 million episodes of patient care.  Between 2004 and 2010, there were 7649 cases of hematuria with a subsequent diagnosis of bladder cancer – 5416 in men, 2233 in women.

The mean time between presentation of hematuria and diagnosis of bladder cancer was 85.4 days for women compared to 73.6 days among men (p<0.001), according to the report.  Similarly, more women than men (17.3% versus 14.1%; p<0.001) experienced a delay in diagnosis greater than 6 months.

Furthermore, women were twice as likely as men to be diagnosed with a UTI (odds ratio 2.32), and less likely to undergo upper tract imaging (OR 0.80), the investigators report.

Dr. Cohn and colleagues say that the findings are a concern on two levels. “First, given the well-described inferior survival outcomes for women with bladder cancer, and the impact of delayed diagnosis on survival, prompt diagnosis of bladder cancer in women is exceedingly important.”

“Second,” they point out, “whereas the data suggest we are disproportionately failing to avoid significant delays in diagnosis in women, approximately 1 in 7 men are also experiencing delays >6 months in diagnosis of bladder cancer.”

In a related editorial, Dr. Benjamin T. Ristau at the University of Pittsburgh Medical Center, Pennsylvania and Benjamin J. Davies say the study provides important insights but doesn’t completely explain why women have worse outcomes..  “Similar to most medical phenomena,” they conclude, “a multifactorial interaction among tumor biology, sex hormones, acute differences in time to diagnosis, and access to care define the problem and the solution.

SOURCE: Sex disparities in diagnosis of bladder cancer after initial presentation with hematuria

SOURCE: Disparity in bladder cancer outcomes

Cancer 2013.