Gender discrepancies in bladder cancer: potential explanations

ABSTRACT

Introduction

Gender differences in urothelial carcinoma of the bladder (UCB) exist. Although men have a higher incidence of UCB, women tend to have poorer outcomes. We have explored and summarized the evidence for gender differences of UCB diagnosis and prognosis, together with reasons for these disparities.

Areas covered

The incidence of UCB is 3–4 times higher in men than women. However, women are more likely to be diagnosed with advanced disease. Women have a higher stage-for-stage mortality compared to men, and their greatest risk of death appears to be within the first 2 years of diagnosis. Survival outcomes following radical cystectomy (RC) and radiotherapy are also poorer in women. Delays in diagnosis, differences in female anatomy, as well as poorer surgical outcomes post-RC appear to contribute significantly to the disparities noted between genders. Other factors such as exposure to risk factors, differential hormone signaling, and carcinogen breakdown may also have a role.

Expert opinion

The gender divide in UCB outcomes has to be addressed. Improved medical and patient education and centralization of RC are recommended.

KEYWORDS:

• Bladder cancer
• cystectomy
• diagnosis
• gender
• outcomes
• prognosis
• women

Article highlights

• Women are more likely to be diagnosed with muscle invasive bladder cancer compared to men.

• Cancer-specific mortality (CSM) rates in women are higher especially in the first 2 years after diagnosis compared to men.

• Poorer survival rates have been reported in women with UCB following RC and radiotherapy. However, women undergoing neoadjuvant chemotherapy have lower CSM and recurrence rates compared to men.

• More women with UCB were treated symptomatically without further investigation compared to men (47% vs 19%) in the year prior to diagnosis.

• Higher operative blood loss, transfusion rates and post-operative complications have been reported in female compared to male RC.

• Suggestions for closing the gap between male and female UCB outcomes include education, as well as centralization of RC and audit outcomes

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.