Closing the Gap: Understanding Gender Disparities in Bladder Cancer Care, hosted by Martha K. Terris, MD, FACS, is a limited series spotlighting unique considerations for bladder cancer diagnosis and treatment among women. Dr Terris is department chair and a professor in the Department of Urology, the Witherington Distinguished Chair in Urology, and co-director of the Cancer Center at the Medical College of Georgia at Augusta University. 

In part 1 of this 3-part series, Dr Terris discussed the prevalence of bladder cancer in women, as well as reasons for diagnostic disparities that contribute to poor treatment outcomes. She noted that this disease is often diagnosed at later stages in women than in men, often resulting in diagnoses of more advanced disease and translating to poorer outcomes. She added that although female patients represent a minority of those with urothelial carcinoma, retrospective data indicate that women tend to be diagnosed at later stages and consequently experience worse survival rates, regardless of the disease stage.

Dr Terris identified several theories explaining why this diagnosis delay occurs. One possible reason is patient-related: women may be less likely than men to consult a physician when they notice blood in their urine because they may be conditioned to dismiss blood if they experience menstrual bleeding. However, physician behavior and bias also contribute to diagnostic disparities, Terris said. Women with suspected hematuria typically receive fewer imaging tests, she continued. Additionally, physicians may be biased, attributing hematuria to uterine bleeding, menstruation, or other benign causes. 

Overall, Terris emphasized that early detection is key. If there is any suspicion of a malignancy, patients should be referred directly to a urologist, she stated. Urologists should be willing to work up cases that might ultimately be recurrent urinary tract infections or radiation cystitis to avoid undiagnosed cases of bladder cancer in women, she concluded.