Bladder Cancer Diagnosis May Be Delayed in Women

Medically Reviewed

If you notice blood in your urine, you may assume you have a urinary tract infection. Other common causes of blood in the urine, or hematuria, are kidney stones, bladder stones, or, if you're a man, a prostate infection (prostatitis). If you're female, there's also a chance it could be bladder cancer.

Although bladder cancer is about three to four times more common in men than in women, women have lower five-year survival rates. This may be because men and women develop different subtypes of bladder cancers. But it may also be because it takes doctors longer to make a bladder cancer diagnosis in women than in men.

A study published in 2013 in BMJ Open of 920 bladder cancer patients in England found that women with hematuria were less likely to have speedy referrals from a general practitioner to a urologist. In fact, 27 percent of the women had to see their doctor three or more times before they were referred to a urologist, compared with 11 percent of the men—even though clinical guidelines in England require any patient with blood in their urine be “referred urgently” to a urologist.

The problem isn’t unique to the United Kingdom. A 2008 study of 926 patients at a U.S. managed-care organization found that 47 percent of men who saw a doctor for blood in their urine were referred to a urologist after their first visit—compared with 28 percent of women who had the same symptoms. Overall, a man had a 65 percent increased likelihood of getting a referral to a urologist than a woman did.

Why the gender disparity? Experts suspect it may have to do with bladder cancer’s initial symptoms, particularly hematuria, which are similar to other less harmful—and more likely—disorders in women, such as a urinary tract infection.

Getting prompt attention

Bladder cancer tends to occur after age 55, with the average new diagnosis at age 73, according to the American Cancer Society.

Fortunately, most bladder cancers are detected while still confined to the inner lining of the bladder wall, called the transitional epithelium. Such superficial bladder cancers, which usually can be treated with minor surgery, have a five-year survival rate of nearly 90 percent.

Invasive bladder cancer spreads from the transitional epithelium, moving through the next three layers of connective tissue, muscle and the fatty tissue that separates the bladder from other nearby organs. Such tumors are much less responsive to therapy than superficial tumors.

Diagnosing bladder cancer

An early sign of bladder cancer is intermittent pink-, reddish- or rust-colored blood in the urine, which is why it’s so important for the cause of hematuria to be promptly diagnosed. However, according to one study, only about 10 percent of people who see their doctors for blood in the urine have bladder cancer.

If you see blood in your urine, your doctor will ask for a urine sample, which will be tested for infection and possibly the presence of proteins released from cancer cells. To make a definitive diagnosis, your doctor will refer you to a urologist for a cystoscopy.

During a cystoscopy, the urologist inserts a slender tube with a light and lens or video camera through the urethra (the opening through which urine exits the body) and into the bladder, allowing him or her to examine the bladder lining and biopsy any suspicious areas.

Most women with blood in their urine don’t have bladder cancer. But all women, especially those over 55, should be alert to the possibility that it can be a sign of cancer. If your doctor doesn’t mention a referral to a urologist, you should ask for one, especially if you have previously seen the doctor for blood in the urine or have any other symptoms associated with the disease.

Read more about conditions that can affect your bladder.