Dr Clinton on Gender Differences in Bladder Cancer Presentation

“A lot of times, women are coming in without blood in the urine, which is why there tends to be a bit of a delay in diagnosis or recognition. Presentation is important when it comes to gender differences, because if you have a patient [with] irritation-type symptoms [such as] frequency or urgency, that may be unrecognized or treated as a urinary tract infection. Oftentimes, this may [actually] represent bladder cancer in women.”

Timothy N. Clinton, MD, an associate surgeon at Brigham and Women's Hospital as well as a surgical oncologist at Dana-Farber Cancer Institute, discussed how bladder cancer presentation can differ between male and female patients.

Clinton noted that many female patients with symptoms that could represent bladder cancer often begin their care journey in the urology space. It is commonly thought that patients with bladder cancer often present with blood in the urine with or without pain, although that is often not the case, he added. Oftentimes, female patients present without blood in the urine, causing delays in recognition and diagnosis of bladder cancer, he noted.

When female patients present to physicians with irritation symptoms such as urinary frequency or urgency, these are often unrecognized or treated as a urinary tract infection, Clinton said. However, these could be signs of bladder cancer, he concluded.

Although male patients have an approximately 4-times higher incidence rate of bladder cancer compared with women, female patients often present with higher-grade disease and experience worse outcomes. Characteristics of the male and female immune systems, differences in circulating hormone levels and hormone receptor expression, and different genetic and epigenetic alterations are biological factors that all likely contribute to disparate incidence rates and outcomes for male and female patients with bladder cancer. Researchers at Dana-Farber Cancer Institute are advancing more tailored approaches to improve early detection, treatment outcomes, and quality of life for female patients.