Urologic Oncologist Discusses Bladder Cancer Diagnosis Delays in Women: "Every Story From My Female Patients Is the Same"

Bladder cancer is more common in men than in women, but women often endure a longer road to a bladder cancer diagnosis than men and face a poorer prognosis.

Mary Beth Westerman, MD, an Associate Clinical Professor in the Department of Urology at the Louisiana State University Health Science Center in New Orleans, says there are two primary reasons why women are more likely than men to have more advanced disease at the time of diagnosis and face a higher risk of recurrence and death.

For one, women with bladder cancer tend to do worse, stage for stage, than men. The biology behind this disparity remains under investigation, with research suggesting that hormones may explain some sex differences in bladder cancer outcomes.

“When we really get into the biology of the cancer, there are different subtypes of bladder cancer and that we’re starting to understand,” Westerman said. “And it seems that women tend to have some of the more aggressive subtypes, compared to men.”

The second reason for the disparity is that signs and symptoms of bladder cancer “tend to be missed” in women, as they can often be mistaken for urinary tract infections (UTIs), Westerman said.

“There’s about an eight-month delay to diagnosis compared to men,” she said. “So, there’s a pretty big lag where bladder cancer is actually progressing, moving along, and … it hasn’t been found yet.”

Women are more likely than men to be treated for alleged UTIs “without further evaluation or referral,” with 55% of women, compared with 78% of men, directly consulting a urologist.

“Every story from my female patients is the same,” Westerman said. “[They say] ‘I started having these symptoms last year. I never had a history of having UTIs. I was treated with antibiotics a couple of times, it just didn’t really seem to help, they would come back.’”

Women on average are treated with antibiotics for a UTI least three times before their bladder cancer diagnosis, whereas men typically are treated only once with antibiotics before a bladder cancer diagnosis.

This makes it critical for clinicians and patients to be aware of potential bladder cancer signs and consider urology referrals if what seems to be a UTI is not resolving in a woman.

“I think that part of it is an education component for physicians and also for patients; that they really need to advocate for themselves,” Westerman said.

Westerman has specific advice for doctors to consider when treating women who present with blood in their urine.

“From a clinician standpoint, women who have blood in their urine attributed to a UTI, they should have another urine [sample] checked a couple of weeks after you’ve treated them to make sure there’s not still blood in there, that there’s not microscopic hematuria,” she said. “I don’t think that that happens a lot of the time.”

Westerman says primary care doctors should keep certain warning signs in mind when treating women who seem to have recurrent UTIs.

“If they’re not getting better, that’s another red flag. Uncomplicated UTI patients they should feel better within 24 hours of starting antibiotics,” she said. “You should have a culture that shows that they’re infected. And their symptoms … they shouldn’t come back after the antibiotic … if they’re not having a period of symptom-free time in there, that’s another red flag.”

References

Gender and Bladder Cancer: A Collaborative Review of Etiology, Biology, and Outcomes

Do differences in clinical symptoms and referral patterns contribute to the gender gap in bladder cancer?

Role of oestrogen receptors in bladder cancer development