BLadder cancer is one of the most common forms of cancer diagnosed in the United States, about 1 in 40 Americans born today will have this cancer at some point in their lives, and the majority of these people will be males over the age of 60. Bladder Cancer It is the fourth most common cancer in American men, accounting for more than 6% of all cancers in males.
But while men are three to four times more likely to develop bladder cancer than women, the disease tends to be more deadly in females. Women are also more likely to be diagnosed with large bladder tumors. why? These are questions that medical researchers have puzzled over for years, but the answers are still elusive. says Dr. Janet Kukreja, associate professor and bladder cancer specialist at the University of Colorado Cancer Center. These gender discrepancies are particularly striking because for many other cancers—such as those of the head and neck, esophagus, stomach, liver, and pancreas—women tend to fare better than men.
Unanswered questions also haunt research on bladder cancer in young adults. Here again, bladder cancers tend to occur more frequently in males than in females. Again, women tend to have more aggressive and advanced tumors than men. However, some of the more common risk factors for bladder cancer in older adults — a history of smoking and also previous exposure to dyes or pesticides — don’t appear to be factors when younger people develop bladder cancer. “It is more common for younger patients to not have a history of smoking or other obvious issues [risk] Exposures,” says Kukreja. “We often have no idea why they get them.”
Exploring the causes of these age and sex differences is an important area of bladder cancer research. Finding answers can improve treatments and outcomes.
Why women with bladder cancer fare worse
Some types of cancer — such as pancreatic cancer — can be difficult to detect because they cause few, if any, noticeable health effects. This is rarely the case for bladder cancers, which often cause symptoms that are hard to miss. “Patients usually see blood in their urine, and that leads them to come in for evaluation,” says Dr. Yair Lotan, a urologist at the University of Texas Southwestern Medical Center in Dallas.
According to a 2014 study in the journal cancerHematuria (blood in the urine) is the most common Symptoms of bladder cancer. That study found that in up to 35% of people who had blood in their urine — enough to turn their urine pink, red, or cola — cancer was the cause. Despite the strong association between hematuria and bladder cancer, women with blood in their urine are less likely than men to be referred to the appropriate specialist. “If a man reports blood in his urine, it will almost always be sent to a urologist,” Lotan says. “Women are more likely to be treated with antibiotics for a urinary tract infection.” Some analyzes have found that women with bladder cancer who report blood in their urine are twice as likely as men to be initially misdiagnosed with a UTI. This occurs in part because UTIs are more common in women than in men, and bloody urine is one of the primary symptoms of UTIs. But it can be a costly mistake. “Bladder cancer is an aggressive disease, so any delay makes a difference,” says Kukreja. She adds that even a month’s delay can have a significant impact on treatment and survival.
Misdiagnosis of the urethra may partly explain why women with bladder cancer tend to experience worse outcomes than men. But they are not the full story. Research has found that after first noticing blood in the urine, women with bladder cancer go through an average of 85 days before receiving a proper diagnosis. For men, the average wait is 74 days. Statistically speaking, this difference is significant. However, it is not significant enough to explain the gender differences in disease outcomes. Biology also appears to play a role. “There has been some work on hormonal factors,” Lotan says. Specifically, some work has found that estrogen receptors in the lining of the bladder may play a role in the formation of cancer cells. The researchers also found that male sex hormones (androgens) also affect the development of bladder cancer cells. It is possible that these sex-dependent biological characteristics alter the activity of bladder cancers in ways that help account for different incidence rates and outcomes.
There may also be some sex-related differences in cancer itself. “When we talk about cancer, we usually describe it by its primary site,” says Dr. Nicholas Coast, urologist and co-director of the Surgical Oncology Program at Children’s Hospital Colorado. “While that’s one way to describe it, there are usually a number of different types of cancer even within a single organ.” In other words, bladder cancer is not a single disease. Like other forms of cancer, it can come in many different subtypes—subtypes that may respond differently to treatment and may be associated with better or worse outcomes. The subtypes of bladder cancer that affect women may be different from those that occur in men, which may explain why women with the disease tend to fare worse. However, research has not yet been able to identify consistent sex-based differences in cancer mutations or other underlying characteristics that explain the difference in outcomes.
One last noteworthy difference between men and women relates to bladder cancer risk factors. Even when the researchers controlled for environmental exposures, such as tobacco use, they found that gender-based differences in incidence persisted. “Even women who smoke for 30 years still have a quarter of the risk of men, and we haven’t been able to narrow down why,” Lotan says.
Obviously, men and women experience bladder cancer differently. Experts are still figuring out why this happens.
Bladder cancer in younger adults
Bladder cancer is very rare in people 20 years of age or younger. Less than 1% of patients with bladder cancer fall into this age group, and the prognosis for these pediatric patients tends to be better than for adults.
“What we found is that the majority of tumors are slow-growing, low-grade tumours,” says Dr. Jonathan Epstein, MD, professor of pathology, oncology, and urology at Johns Hopkins University School of Medicine. He explains that this is the lowest-risk category of bladder cancers, and young adults with these tumors rarely die as a result of the disease. In many cases, the tumor is surgically removed and no other treatment (such as chemotherapy) is required.
Epstein says it’s not clear why children get these cancers. He and his colleagues looked for links to a parent’s smoking history or occupational exposure, as well as inherited genetic factors, but found no association. “It’s basically just bad luck,” he says.
To a lesser extent, some of these same patterns are seen in younger adults — those under 50 — who develop bladder cancer. For example, some work suggests that these cancers are more indolent, meaning slower to spread, than bladder cancers in the elderly. There is also some evidence that survival rates are better in this age group than in older patients. However, much research in this area has yielded conflicting results. “Tumours in younger patients may be less aggressive, but it’s very hard to tell because the incidence in this age group is so low,” Lotan says. He says other, non-cancerous factors could better explain any apparent differences between younger and older bladder cancer patients.
For starters, it’s possible for younger, healthier adults to be diagnosed at earlier stages than in older adults, which can lead to better outcomes. Younger patients may also receive different treatments than older patients dealing with other health issues, and this may improve survival rates. “If a patient is 85 years old and their life expectancy is in the range of one to five years, we may treat them less severely than we would treat them in their 40s or 50s,” Lotan says. Thus, at this point, it is difficult to say whether bladder cancers in younger adults are truly milder.
It is also difficult for researchers to establish strong links between bladder cancer and smoking or other environmental risk factors in adults younger than 50. “With an older patient who smoked for 30 years, it’s a lot easier to find these associations,” Lotan says. “With younger patients, we are often baffled as to why they have that.”
Catch bladder cancer sooner
Cancer screening It is rarely evident. The benefits of getting cancer early must be carefully weighed and weighed against the costs–in dollars, in time, in resources–of thousands of potentially unnecessary screening tests. While there is some evidence that screening people with known risk factors for bladder cancer may be beneficial, this is not currently standard practice. This means that it is important that people do not ignore symptoms of bladder cancer—symptoms that may be overlooked or misinterpreted in women, young adults, and those who are statistically less likely to develop the disease.
“Early detection is really important,” says Kukreja. The job of identifying bladder cancer in the first place rests with a person’s doctor or care team, she says, but there are things people can do to ensure the cancer is caught as quickly as possible.
For starters, don’t ignore signs of blood in your urine. “Blood in urine is never normal, so you need to see a doctor,” she says. While a handful of things—urinary tract infections, kidney stones, even intense exercise—can lead to bloody urineNo one should put off seeing a doctor if they develop these symptoms. “She always deserves attention,” she adds. Other red flags of bladder cancer include pain or burning during urination, urinating more than usual, or difficulty urinating. Again, all of these symptoms are most likely due to a UTI or some non-cancerous issue, but that doesn’t mean you should ignore them. “Until you see the provider, you can’t bring up what’s going on,” she says.
While these are useful preventatives, it bears repeating that bladder cancer is less common in women than in men, and is still rare in young adults and adults under the age of 50. experts
They are working to learn more about how this cancer behaves in these atypical groups. But there are still many unanswered questions.
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