Closing the Gap: Understanding Gender Disparities in Bladder Cancer Care, hosted by Martha K. Terris, MD, FACS, is a limited series spotlighting unique considerations for bladder cancer diagnosis and treatment among women. Dr Terris is department chair and a professor in the Department of Urology, the Witherington Distinguished Chair in Urology, and co-director of the Cancer Center at the Medical College of Georgia at Augusta University.
In part 2 of this 3-part series, Dr Terris discussed the disparities in treatment and outcomes for women with bladder cancer. Although bladder cancer is less common in females than in males, female patients tend to have significantly worse outcomes, Terris explained. Delayed diagnosis is a contributing factor, but the exact reasons for the poorer prognosis are not fully understood, she emphasized.
Treatment difficulties begin surgically, according to Terris. From a surgical perspective, she noted that, performing a cystectomy on a woman is more challenging due to factors like pelvic varicosities and differing fat distribution, which complicate stoma creation.
In terms of medical treatment, Terris also explained that women exhibit worse tolerability and higher rates of discontinuation of immunotherapy, and that they often experience poor efficacy outcomes regardless of whether they complete the course of treatment. These differences between men and women may be linked to factors such as hormonal influences or antibody introduction during pregnancy. Conversely, classic cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy have been shown to have similar overall survival and disease-free survival in eligible female and male patients.
Biologically, Terris also reported that tumors in women may exhibit more effective immune escape mechanisms, possibly connected to differences in the bladder microbiome. The presence of bacteria in bladder tumors has been found to be enriched in patients who did not respond to neoadjuvant chemotherapy, which is relevant as women are more prone to bladder colonization, she added. Overall, Terris emphasized that oncologists must be aggressive in treating women with bladder cancer, despite surgical complexities, and highlighted that early detection is key.
