Urologic Oncologist: Bladder Cancer Care for Women Continues to Evolve

Bladder cancer care, particularly for women, is continuing to evolve, as greater awareness and understanding of sex differences develop alongside new strategies to improve diagnosis and treatment.

Mary Beth Westerman, MD, an Associate Clinical Professor in the Department of Urology at the Louisiana State University Health Science Center in New Orleans, outlined recent developments in bladder cancer care for women.

“I’d say over the last maybe three to five years, there’s been a lot more push for specifically looking at what is the experience like for women, how do we understand what the counseling looks like before [surgery] and afterwards, and what are the unmet needs here, and involving patients in those discussions,” Westerman said.

She’s also seen a change in the demographic composition of the urology field.

“Urology has been predominantly very male dominated, and that is changing. There are more women in urology, there are more women [who are] urologic oncologists,” Westerman said. “And so, I think that there’s maybe been a push from some of the younger urologic oncologists to talk about these things, and talk about how we can maybe refine, or change, modify some of our surgical techniques, of course without compromising patients’ outcomes long term.”

Westerman has seen many developments during her career and training, which have spanned about a decade between her residency and fellowship work and her current practice.

“When I started, we had one type of chemotherapy for patients with bladder cancer, with two options, basically, but that was it; and there hadn’t been anything in 20 years that had changed the nonsurgical care,” she said. “And now there are so many drugs available for patients with more advanced disease. For patients without advanced disease, we have a lot more options for bladder preservation.”

Treatment options have expanded greatly over the past decade, “which is also great for cancer in the bladder that maybe doesn’t respond to the one treatment that we have,” Westerman said.

“We now have more, there’s so many more drugs in development,” she added. “And there’s a lot of interest even in preserving the bladder and treating with chemotherapy, radiation instead of with surgery. And that’s becoming a little bit more widely accepted and more mainstream. And so, I think, to me, there’s a lot of exciting stuff and hopefully we can continue to make advances and improve care for our patients.”

The understanding of sex differences in bladder cancer also continue to evolve.

“The sequencing of cancer and the cancer biology is getting more accessible to researchers. I think there’s going to be a better understanding of why women have more aggressive biology, is there something at a very unique cellular level that that is driving this?” Westerman said. “And I think we’re getting closer potentially to understanding a lot of that.”

In terms of diagnosis, there are some “ways potentially to screen better, diagnose earlier [that] are really exciting,” Westerman said.

Some potential methods include urine-based tests that primary care doctors could use for early screening.

“I think we’re potentially a little ways out from that, but if we have the ability at some point in the future to do that and identify these patients earlier, I think that’ll be a great upgrade and step forward for us,” Westerman said.

Patient education strategies are also moving forward. This education can be provided by clinicians, but also through broad public outreach about the signs and symptoms of bladder cancer in women.

“I think as hopefully we get that out to patients as well, they’ll be able to hopefully advocate for themselves and get in a little bit earlier,” Westerman said.