Traditional factors may not explain why bladder cancer is deadlier for some

Bladder cancer is more likely to be fatal for women and African-Americans, but University of Rochester researchers report that the factors traditionally cited for these higher mortality rates are responsible for only about one-third of the difference between white men and women and up to two-thirds of the difference between African-Americans and their white counterparts.

“We’ve known that the disease is likely to be more advanced in women and African-Americans by the time they’re diagnosed,” said Edward Messing, MD, of the University of Rochester Medical Center’s James P. Wilmot Cancer Center, Rochester, NY. “Like many doctors, I long assumed that the delay in diagnosis was the reason why the disease is more deadly for these patients. I was surprised to find that recognized factors, like a delay in diagnosis, explain only part of the difference.”

In a recent study, Dr. Messing and colleagues speculate that differences in disease-related mortality may be attributed to the choice of treatment, differences among tumors that were not taken into account in the study, and access to health care. Differences related to gender are likely caused by factors not currently understood, such as hormonal differences, Dr. Messing said. Also, men are more likely to report blood in their urine to their physicians.

The researchers analyzed Surveillance, Epidemiology, and End Results (SEER) data for more than 100,000 patients diagnosed with bladder cancer between 1990 and 2003. They found that in the first year after diagnosis, women were approximately 80% to 114% more likely to die from the disease than their male counterparts were. That increase was less in year 2, when women were about 52% to 55% more likely to die from their disease than men were.

African-Americans were about 73% to 103% more likely than their white counterparts to die from bladder cancer within the first 2 years after diagnosis, and about 40% to 117% more likely to die 3 to 4 years after diagnosis.

The study was published in Cancer (2009; 115:68-74).