The Impact of Gender on Oncologic Outcomes of Bladder Cancer

Dong-Ho Mun; Shoji Kimura; Shahrokh F. Shariat; Mohammad Abufaraj

Disclosures

Curr Opin Urol. 2019;29(3):279-285. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: The purpose of this article is to review the current literature on the impact of gender on oncologic outcomes of bladder cancer (BCa).

Recent findings: Women are more likely to experience disease recurrence, progression, and/or death across all disease states. Furthermore, women are less likely to respond to intravesical therapy for nonmuscle invasive BCa. These disparities are explained by several hypotheses such as differential exposure to environmental carcinogens, hormonal factors, and/or disease management. Additionally, it has been shown that women suffer from delays in diagnosis because of inefficiencies in healthcare delivery. On genomic analyses, women were found to be more likely to harbor basal subtypes of BCa compared with men.

Summary: A steadily growing body of evidence reveals that women present with more advanced BCa and have stage-for-stage worse outcome compared with men. The underlying mechanisms for this gender difference are multifactorial. Further studies are needed to elucidate the molecular underpinning of this gender-gap and subsequently explore potential novel gender-specific management strategies.

Introduction

In 2018, it was estimated that 81 190 patients had bladder cancer (BCa) diagnosis with 17 240 succumbed to their disease in the United States alone.[1] Although men have three to four times higher incidence of BCa,[2] women present with more advanced disease at the time of diagnosis and show worse survival outcomes after treatment.[3] Indeed, among the 10 most common cancers in both genders, BCa is the only one in which women have a worse prognosis than men, even after adjusting for the effect of disease stage at diagnosis.[4] There has been a growing body of literature researching this gender disparity suggesting various possible causes such as differences in exposure to risk factors,[5] in timeliness of adequate medical care,[6,7] in tumor and host biology (i.e., hormonal exposure and effect), and in disease management.[8]

The most important risk factor for BCa is tobacco smoking followed by occupational exposure to aromatic amines such as in rubber and chemical-dye industries.[9] The higher incidence of BCa in men is attributed to the higher prevalence of smoking and the more frequent exposure to occupational hazards as compared with women.[9] However, these differences in exposure risk do not explain the gender-gap fully.[3,5,6] Indeed, the rate of decline in smoking, over the last three decades, has been less pronounced in women than in men, and today, women seem to be exposed to occupational hazards as commonly as men.[5,10] Despite these 'equalizing' exposure risks, BCa incidence remains equally unbalanced between the two genders with men getting the cancer more commonly. One explanation for this stability in cancer risk is the latency between carcinogen exposure and BCa development.

In this review, we present an update of the recent literature on the differences in BCa outcomes between the genders and discuss the possible underlying causes of this gender disparity and future directions.

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