Dr Berg on UTIs and Bladder Cancer Referral in Women

“When [a patient] has [UTIs] every month or every other week, and there's nothing to really explain it, [patient anxiety] really does build up.”

Stephanie A Berg, DO, a medical oncologist at the Lank Center of Genitourinary Oncology at Dana-Farber Cancer Institute and an instructor of medicine at Harvard Medical School, outlined considerations for women experiencing frequent urinary tract infections (UTIs) and when referral to a bladder cancer specialist may be appropriate.

In honor of National Women’s Health Week, Berg discussed key considerations for female patients in terms of arriving at a bladder cancer diagnosis. Read more from Berg and Timothy N. Clinton, MD, also of Dana-Farber Cancer Institute, on the challenges of diagnosing bladder cancer in female patients compared with men.

Berg explained that recurrent UTIs in women represent a significant clinical and psychological burden that extends beyond the immediate infectious process. While isolated UTIs are common in the general population, patients experiencing frequent recurrences, such as monthly or biweekly infections without a clear underlying explanation, require a more comprehensive evaluation to exclude structural or malignant etiologies, including bladder cancer.

Berg emphasized the emotional impact associated with recurrent UTIs, including heightened anxiety, frustration, and depression, particularly in women who feel their concerns are repeatedly attributed to uncomplicated infection. In many cases, patients cycle through repeated courses of antibiotics without definitive diagnostic assessment, contributing not only to persistent symptoms but also to delays in identifying potentially serious underlying pathology, she noted.

For primary care clinicians, recurrent or refractory urinary symptoms should prompt consideration of referral to urology, particularly in patients with high-risk features, Berg continued. She pointed out how primary care providers may initiate imaging studies such as CT or MRI, office-based cystoscopy remains a critical diagnostic tool for direct visualization of the bladder and lower urinary tract. Early urologic evaluation is especially important when recurrent infections are unexplained, associated with hematuria, or occur in patients with recognized bladder cancer risk factors, she underscored.

Berg also highlighted the importance of patient advocacy and multidisciplinary collaboration, encouraging patients to report persistent or worsening symptoms. She said that maintaining close communication between primary care and urology may help reduce diagnostic delays.