Women With Bladder Cancer Have Higher Mortality Rates

Early diagnosis in cases of bladder cancer is essential to treat the disease promptly and prevent it from progressing to other areas of the pelvis—and, later, to other organs of the body. Despite this necessity, the evidence shows that on many occasions, women are not diagnosed in time.

"Women with bladder cancer are diagnosed later than men. On average, there is about an eight-month delay from symptoms until diagnosis for women," said Mary Beth Westerman, M.D., a urologic oncologist and an assistant professor of urology at Louisiana State University Health Sciences Center New Orleans.

However, men are more likely to develop bladder cancer. The American Cancer Society (ACS) estimates that more than 82,000 new cases of bladder cancer will be diagnosed in 2023: 19,870 in women and 62,420 in men.

Despite the chances, the death rate in women is higher because their cases are typically diagnosed at more advanced stages.

What is bladder cancer?

The bladder is an organ near the pelvis in which urine from the kidneys is stored until the brain sends signals to go to the bathroom.

The uncontrolled growth of bladder cells leads to the development of a tumor that starts, in most cases, in the inner lining of the bladder. Untreated bladder cancer can spread to other parts of the body, such as the lungs and liver. Therefore, early detection is essential to initiate treatment and increase the likelihood of survival.

Half of bladder cancers are detected when the cancer is noninvasive and still located in the inner layer of the bladder wall. According to the ACS, 1 in 3 bladder cancers at the time of diagnosis have spread to the deeper layers in the bladder. Only about 5 percent of bladder cancers have already spread to distant parts of the body, while the other cases have spread outside the bladder to nearby lymph nodes or tissues.

Why is the diagnosis in women often later?

For a woman, it is easy to mistake blood in the urine—one of the main symptoms of bladder cancer—as a symptom of other common problems of the gynecological or urinary system or the menstrual cycle. The consequences of these similarities are reflected in diagnostic outcomes.

"The symptoms of bladder cancer are much more likely to be assumed to be due to a urinary tract infection, which happens less frequently with men. Because the diagnosis is delayed, women are more likely to be diagnosed at a later—more advanced—cancer stage," Westerman explained.

When you go directly to your doctor with your symptoms, you can receive an earlier diagnosis. Even though most of the time it is just a urinary tract infection, you should check to make sure. Otherwise, you may delay the required treatment.

What do the statistics say about late diagnosis?

"Delayed diagnosis is attributed to a 34 percent increased risk of death from bladder cancer and a 15 percent increased risk of death from any cause," Westerman said. "Women with bladder cancer have worse five-year survival rates than men, likely due to the delay in diagnosis."

The differences in prognosis are not based solely on a gender gap.

"It is important to mention that in the United States, black individuals, regardless of gender, are also disproportionately affected by diagnosis delay," Westerman said.

Black women receive more advanced and aggressive bladder cancer diagnoses compared with rates in other populations, according to Bladder Cancer Advocacy Network.

Who is at risk?

Bladder cancer can develop at any age, but there is an increased risk in older people.

Other risk factors for bladder cancer include:

• Smoking. Due to the buildup of chemicals in urine, people who smoke have the highest risks of developing bladder cancer. These chemicals, which are absorbed through smoke, can cause damage to the lining of this organ.
• Exposure to certain chemicals at work. Frequent contact with chemicals such as rubber, dyes and petrochemicals increases the chance of developing bladder cancer. Some of the industries most at risk include paint, textiles, rubber and leather.
• Family history of Lynch syndrome. This condition is transmitted from parents to children and increases the risk of some cancers of the urinary tract, colon, uterus, liver and ovaries, among others.
• Family and personal history of bladder cancer. If a close blood relative has had bladder cancer, you have a higher risk of developing it, although it is not the greatest risk. People who have had bladder cancer in the past face a high risk of recurrence, and for that reason, they always have a closer follow-up after finishing treatment.
• Chemotherapy and radiation to the pelvis. People who have received cyclophosphamide or ifosfamide chemotherapy and radiation as treatment for previous cancers in the pelvis also have a higher risk rate.

For women, bladder cancer is more common past the age of 60, according to Westerman.

"Women who have long-term catheters or a long history of recurrent infections are also at increased risk of bladder cancer," she added.

Gender differences

The symptoms of bladder cancer are similar in all people. However, in women, blood in the urine, the urgency to go to the bathroom, burning and other indicators are commonly mistaken for urinary tract infections (UTIs), which can delay detection until after the tumor has spread.

Differences between women and men with bladder cancer are noted in:

• Risk. Men are more likely to develop bladder cancer.
• Diagnosis. Many women do not get a prompt diagnosis, which allows time for the cancer to spread.
• Prognosis. Survival rates in women are lower due to diagnosis commonly occurring at advanced stages.

What you should know

Here are some additional facts and notes about bladder cancer:

• The risk of bladder cancer in women is 1 in 88.
• Approximately 23 percent of bladder cancer diagnoses are in women.
• Women tend to be diagnosed with more advanced bladder cancers, which translates into worse outcomes.
• 90 percent of people diagnosed with bladder cancer are older than age 55.
• White men are more likely to develop bladder cancer than Latinos and African Americans.
• In the early stages, bladder cancer is very likely to be curable.
• Despite the incidence rates, it should not be thought that bladder cancer affects only older white men.