UroToday.com – Among patients with bladder cancer (BC), women are more likely to die from this disease when compared to men of the same age and race, and African-American patients are more likely to die from BC when compared to white patients of the same age and sex.

These differences in mortality could potentially be explained by factors such as delay in diagnosis, variation in the choice and efficacy of therapies, and possibly differences in the biology of disease. Theoretically, delay in diagnosis could be a very important factor because early symptoms of BC among women may often be attributed to more common benign conditions (such as urinary tract infections). For African-American patients, late presentation may result from reduced access to healthcare.

Delay in diagnosis would affect mortality primarily through more advanced stages at presentation. Although this occurs to various degrees in white women and African-American patients, our analysis indicates that adjustment for stage (as well as certain other factors) does not entirely eliminate the excess hazard of death from BC among women and African-Americans.

It is possible that sex and racial differences in the extent of disease at diagnosis involve the sub-stages within each stage (e.g., T2a vs. T2b or T3a vs. T3b). Because information on sub-stages was not available for most patients in our study cohort, we did not include this variable in the analysis. Several recent studies concluded that among patients with a given stage, the sub-stages have no independent effect on survival [1-3]. However, all patients in these studies were treated with cystectomy. The effect of sub-stages on survival of patients treated with bladder preservation remains unknown.

Although age, grade, histologic type, and stage do not account for all of the differences in BC mortality between the sexes and races – they account for a decent amount (particularly between races). While grade, tumor type, and age are non-modifiable risk factors, stage can be influenced by early detection strategies [4], and even without a formal screening program, awareness on the part of patients and providers could minimize the stage differences and potentially reduce mortality from BC.

References

[1] Boudreaux KJ, Clark PE, Lowrance WT, Rumohr JA, Barocas DA, Cookson MS, et al. Comparison of American Joint Committee on Cancer pathological stage T2a versus T2b urothelial carcinoma: analysis of patient outcomes in organ confined bladder cancer. J Urol 2009;181:540-546
[2] Boudreaux KJ, Chang S, Lowrance WT, Rumohr JA, Barocas AB, Cookson MS et al. Comparison of American Joint Committee on Cancer pathologic stage T3a versus T3b urothelial carcinoma: analysis of patient outcomes. Cancer 2009;115:770-775
[3] Quek ML, Stein JP, Clark PE, et al. Microscopic and gross extravesical extension in pathological staging of bladder cancer. J Urol 2004;171(1):640-645
[4] Messing EM, Madeb R, Young T, Gilchrist KW, Bram L, Greenberg EB, Wegenke JD, Stephenson L, Gee J, Feng C. Long-term outcome of hematuria home screening for bladder cancer in men. Cancer. 2006 Nov 1;107(9):2173-9.

Written by Emil Scosyrev and Edward Messing as part of Beyond the Abstract on UroToday.com.

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