Delay in Diagnosis of Bladder Cancer Longer in Women Than Men

December 06, 2013

By Robert Saunders

NEW YORK (Reuters Health) Dec 06 - 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 U.S. 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 7,649 cases of hematuria with a subsequent diagnosis of bladder cancer -- 5,416 in men, 2,233 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.

"While a 2-week discrepancy may not in and of itself be clinically significant, women were more likely than men at each time point (3, 6 and 9 months) to experience a delay in diagnosis," Dr. Cohn told Reuters Health via email.

For example, 17.3% of women experienced a delay in diagnosis greater than six months, versus 14.1% of men (p<0.001). 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."

"It is likely that we can improve outcomes for both men ... and women by diagnosing urothelial malignancy in a more timely manner," Dr. Cohn concluded. "As urologists, we may need to do a better job educating patients and primary care physicians about the importance of urologic evaluation for hematuria without an obvious benign cause."

In a related editorial, Dr. Benjamin T. Ristau at the University of Pittsburgh Medical Center, Pennsylvania, and Dr. 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: http://bit.ly/1d0SN7y and http://bit.ly/1d0SN7y Cancer 2013.

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