Female kidney and bladder cancers diagnosed late

"Women with kidney or bladder cancer are twice as likely as men to need multiple visits to their doctor before being diagnosed," reports The Daily Telegraph.

Previous research has found that in England there is a slightly higher five-year survival rate for men (57%) with bladder cancer than for women (44%).

In addition, previous studies have also suggested that women with urinary tract cancers may be diagnosed less promptly than men with the same cancers. This new study attempted to see whether this gender discrepancy really exists.

The researchers identified 920 patients with bladder cancer (252 of whom were women) and 398 patients with renal (kidney) cancer (165 of whom were women). These patients were included in a clinical audit taken in England from 2009 to 2010.

After looking at the data the researchers found a significant difference in the time it took male and female patients to be referred after going to their GP with symptoms.

Women with bladder and renal cancer were more likely than men to require three or more consultations with a GP before being referred. They also experienced longer time intervals between first going to their GP with symptoms and hospital referral.

Differences were seen even when patients went to the doctor because of visible painless blood in the urine (haematuria). This is a symptom that should prompt urgent referral, according to guidelines.

This research strongly suggests that there is a need to reinforce existing guidelines on referral for haematuria and to develop new diagnostic decision aids and tests for patients who present without haematuria.

Where did the story come from?

The study was carried out by researchers from the University of Cambridge, the National Cancer Intelligence Network, Bangor University and the University of Durham.

It was funded by the National Institute for Health Research.

The study was published in the peer-reviewed British Medical Journal Open, which is an open-access journal.

This research was accurately covered by The Daily Telegraph and the Mail Online website.

Some of the media speculate that the gender differences may be due, in part, to the mistaken understanding of some GPs that haematuria is a common ‘women’s problem’ that does not require further investigation. This type of speculation is unproven.

What kind of research was this?

This was an analysis of the national audit survey of cancer diagnosis in England between 2009 and 2010. It aimed to determine whether women experience greater delays in the diagnosis of bladder and renal (kidney) cancer after going to their GP with symptoms than men, and the reasons for any gender inequalities seen.

A cross-sectional study of this kind is the ideal study design to show whether a gender inequality in the promptness of diagnosis of bladder and renal cancer exists.  

What did the research involve?

The researchers analysed data from the (English) National Audit of Cancer Diagnosis in Primary Care (2009 to 2010). This contains information on different aspects of the diagnostic process collected by GPs from approximately 14% of practices in England.

The researchers identified 920 patients with bladder cancer (252 of whom were women) and 398 patients with renal cancer (165 of whom were women).

The researchers looked at whether there were any differences between men and women in:

• the proportion of patients who had three or more consultations before being referred
• the number of days from first presentation to referral
• the proportion of patients who presented with visible haematuria
• the proportion of patients investigated in primary care

What were the basic results?

The researchers found that, despite a similar proportion of women and men presenting with haematuria:

• women with bladder cancer required three or more pre-referral consultations significantly more often than men (27% versus 11%)
• women with renal cancer required three or more pre-referral consultations significantly more often than men (30% versus 18%)
• it took longer for women with bladder and renal cancers to be referred after presenting with symptoms

After adjusting for age, haematuria and the use of primary-care-led investigations, the researchers found that:

• being a woman was associated with significantly higher (three times greater) odds of three or more pre-referral consultations for bladder cancer (odds ratio [OR] 3.29, 95% confidence interval [CI] 2.06 to 5.25)
• being a woman was associated with significantly higher (90% greater) odds of three or more pre-referral consultations for renal cancer (OR 1.90, 95% CI 1.06 to 3.42)

The researchers approximate that each year in the UK 700 women with either bladder or renal cancer experience a delayed diagnosis because of their gender, of whom more than a quarter present with visible haematuria. 

How did the researchers interpret the results?

The researchers conclude that “there are notable gender inequalities in the timeliness of diagnosis of urological cancers. There is a need to both reinforce existing guidelines on haematuria investigation and management and develop new diagnostic decision aids and tests for patients who present without haematuria”. 

Conclusion

This study of a small number of patients in England with bladder and renal cancer diagnosed between 2009 and 2010 has found that women with bladder and renal cancer are more likely than men to require three or more consultations with a GP before being referred, and that they experience longer time intervals between presentation and hospital referral.

Gender differences were also observed for patients presenting with and without visible haematuria (blood in the urine), suggesting that doctors often interpret the clinical importance of haematuria differently in men and women, despite the fact that NICE recommends that patients with painless visible blood in their urine be referred.

This research suggests, as the researchers conclude, that there is a need both to reinforce existing guidelines on haematuria investigation and to develop new diagnostic decision aids and tests for patients who present without haematuria.