The sex gap in bladder cancer survival: a missing link in bladder cancer care?

Paul Toren, Anna Wilkins, Keval Patel, Amy Burley, Typhaine Gris, Roger Kockelbergh, Taha Lodhi, Ananya Choudhury, Richard T Bryan*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

The differences in bladder cancer outcomes between the sexes has again been highlighted. Uncommon among cancers, bladder cancer outcomes are notably worse for women than for men. Furthermore, bladder cancer is three to four times more common among men than among women. Factors that might explain these sex differences include understanding the importance of haematuria as a symptom of bladder cancer by both clinicians and patients, the resultant delays in diagnosis and referral of women with haematuria, and health-care access. Notably, these factors seem to have geographical variation and are not consistent across all health-care systems. Likewise, data relating to sex-specific treatment responses for patients with non-muscle-invasive or muscle-invasive bladder cancer are inconsistent. The influence of differences in the microbiome, bladder wall thickness and urine dwell times remain to be elucidated. The interplay of hormone signalling, gene expression, immunology and the tumour microenvironment remains complex but probably underpins the sexual dimorphism in disease incidence and stage and histology at presentation. The contribution of these biological phenomena to sex-specific outcome differences is probable, albeit potentially treatment-specific, and further understanding is required. Notwithstanding these aspects, we identify opportunities to harness biological differences to improve treatment outcomes, as well as areas of fundamental and translational research to pursue. At the level of policy and health-care delivery, improvements can be made across the domains of patient awareness, clinician education, referral pathways and guideline-based care. Together, we aim to highlight opportunities to close the sex gap in bladder cancer outcomes.

Original languageEnglish
Number of pages12
JournalNature reviews. Urology
Early online date21 Aug 2023
DOIs
Publication statusE-pub ahead of print - 21 Aug 2023

Bibliographical note

© 2023. Springer Nature Limited.

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