Blog Action Day: inequality hurts women with bladder cancer

Blog Action Day: inequality hurts women with bladder cancer
To see all of the blogs for Blog Action Day, click here

Bladder cancer is primarily a disease of white men in their mid-sixties and older. Men are three to four times more likely to be diagnosed.

However women, and African American women in particular, are disproportionately more likely to die from bladder cancer. At diagnosis women are far more likely to be at an advanced stage.

According to physician researchers Mark Katz and University of Chicago’s Gary Steinberg, these disparities are quite possibly because of “unequal or inferior treatment.”

Typically patients are diagnosed with bladder cancer because of the presence of blood, microscopic or visible, in the urine. One study showed that women were more than twice as likely to have had three or more visits to a primary care physician before being referred to a urologist.

Being treated for a urinary tract infection, a UTI, after a finding of blood in the urine was the “single strongest independent predictor of delay in diagnosis of bladder cancer,” doubling the risk of delay.

And so it was with me. After my first visit to my primary physician I was treated for a UTI. I called the doc because of blood in my urine some months later and was prescribed antibiotics over the phone. On my next visit, three months after that, I was sent to the emergency room.

Our healthcare system treats women unfairly with regard to these symptoms, but I want to make clear that I don’t really blame my GP.

I suspect that insurance companies frown on docs ordering the expensive and invasive test necessary to diagnose cancer in the bladder, especially for women who frequently have UTIs.

It is certainly obvious that GPs aren’t getting the education they need about these symptoms and bladder cancer.

Having a “man’s” disease also means inequality during treatment.

When I first went to my urologist’s office, following diagnosis after a few days in the hospital, I walked into a waiting room full of older men.

Cancer is an alienating disease. It sets you apart in ways that no one wants to be. Having bladder cancer is more alienating still. Except for my online support group, I don’t know any other women with my disease.

The first examination room in which I met my doctor didn’t even have a chart of the female urinary system. (I gave my urologist a chart for that room for Christmas one year and write about it here.)

I have never felt more alone in my life than I did in those first few months after diagnosis. Surrounded by men in the waiting room, I went into examination rooms designed for men with images of men and drug advertisements for men.

It’s hard to feel equal in such circumstances.

In the midst of that alienation, however, my doctor was and is a person I trust to provide the best medical care possible. There is no doubt in my mind that his care and my treatment are fair and just.

If life isn’t fair and if our healthcare system imposes unequal treatment, I still count myself lucky. Though delayed, my diagnosis was Stage One and I am in remission.

I urge you, however, to not rely on luck. If you see blood in your urine, whether you’re a man or a woman, whether it’s the slightest amount, see a urologist. If you’re diagnosed with a UTI, check those lab results for a report of microscopic blood in the urine, and demand to see a urologist if it’s present.

Mark H. Katz and Gary D. Steinberg's article, "Sex and Race in Bladder Cancer: What We Have Learned and Future Directions" was published in the journal Cancer on January 1, 2009.

Joshua A. Cohen's article, "Sex Disparities in Diagnosis of Bladder Cancer After Initial Presentation with Hematuria" was published in the journal Cancer in February 2014.


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