April 14, 2023 – Did you know that one in every 91 women will develop bladder cancer in their lifetime?
Recent Chinese research found that women with the disease have a worse prognosis than men, possibly because women are often diagnosed with a later stage of bladder cancer.
Read on for a look at what to know about bladder in women.
Bladder cancer survival rates for women may lag behind because women are often diagnosed at a later stage, said Joaquim Bellmunt, MD, PhD, director of the Bladder Cancer Center at Dana-Farber Cancer Center in Boston and an associate professor of medicine at Harvard Medical School.
The National Cancer Institute reports that the most common type of bladder cancer for both women and men is urothelial carcinoma, which starts in the innermost part of the bladder. Although research shows that white women are twice as likely to get bladder cancer, Black women with bladder cancer often have the most advanced and aggressive tumors, according to data from the Bladder Cancer Advocacy Network.
One of the challenges that could explain why women have a more severe course of the disease is that it’s often misdiagnosed as a simple urinary tract infection.
“In some women, the symptoms can be similar to a UTI,” said Bellmunt. “Women may receive treatment for a UTI, in fact, their symptoms improve, but then recur.”
Having symptoms such as dark or orange urine, a burning sensation when you urinate, and frequent urination, as well as post-menopausal bleeding, you might consider seeing your doctor.
What Raises a Woman’s Odds of Bladder Cancer?
A number of risk factors likely come into play, researchers say.
“Smoking, certain industrial chemicals, arsenic in some drinking water, being over age 55, or not drinking enough water are risk factors,” said William L. Dahut, MD, the chief scientific officer at the American Cancer Society. It’s thought that the more water you drink, the more toxins and potential carcinogens you flush out of your body.
Specifically, smoking is a significant risk factor for bladder cancer.
“Toxins in cigarettes and other chemicals are excreted in urine, and those carcinogens have prolonged contact with the bladder before they are ultimately released,” said Emily K. Feld, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center in Commack, NY.
But "smoking is not the only underlying cause of bladder cancer,” said Bellmunt. “Only about 50% of the patients we see have a history of smoking.”
In terms of chemical exposure, aromatic amines, which are many dyes that are used in the textile industry, may raise a woman's risk if she works with them. There’s also been concern that coloring your hair could be a possible risk factor.
But for now, “there’s no conclusive link between hair dyes and bladder cancer,” Bellmunt said.
Family history may also play a role. A new study presented at the 2023 European Association of Urology Annual Congress found that a urine test may be able to predict 10 gene mutations up to 12 years before bladder cancer is diagnosed.
What Are the Symptoms of Bladder Cancer in Women?
Some additional symptoms may include:
- Blood in your urine (hematuria), which can look bright red or be cola-colored
- Pain when you urinate
- Back pain
“While symptoms may be similar for both men and women, how they are interpreted can be different” said Feld. “In women, blood in the urine may be overlooked as a possible sign of bladder cancer, since it can have a far less serious explanation for many people. Blood in the urine may be confused with post-menopausal uterine bleeding. If blood in the urine is being attributed to a urinary tract infection, it is important to check a urine culture to confirm there is truly an infection.”
What Are the Treatment Options for Women with Bladder Cancer?
Surgery is a common first step.
“Women with very early-stage bladder cancer, can be cured with surgery – known as TURBT, or transurethral resection of bladder tumor,” said Feld. “This is followed by intravesical therapy, in which a treatment called BCG is delivered directly into the bladder. For women with muscle-invasive disease, which is more advanced cancer but is still confined to the bladder, a common treatment is removal of the bladder. During the procedure, pelvic lymph nodes and the uterus and ovaries are also removed in post-menopausal women.”
Radiation and chemotherapy are also mainstays of treatment. But a number of cutting-edge options are also proving to be very effective.
“In recent years, many new treatments for advanced bladder cancer have been developed, and are used either after chemotherapy, or sometimes in lieu of chemotherapy,” Feld said. One of these therapies, known as immunotherapy, works by allowing the immune system to recognize and attack cancer cells. Pembrolizumab and avelumab are two immunotherapies, known as checkpoint inhibitors, and are commonly used for advanced bladder cancer.”
New medication is also available.
The FDA in December approved Adstiladrin, a gene therapy for non-muscle invasive bladder cancer that has progressed after standard therapy Dahut said.
“In addition, several drugs targeting the immune system have received FDA approval for patients with advanced disease. Finally, erdafitinib was a targeted therapy approved a few years ago for patients with advanced disease with a very specific tumor mutation," he said.
Because early intervention is crucial, don’t wait to alert your doctor to any symptoms you have that may mean bladder cancer. The good news: So many innovative treatment options means more hope for patients at all stages of the disease.
“With multiple new therapies available for bladder cancer, there are ongoing trials combining existing therapies together, as well as moving them earlier in the disease course, with the goal of improving survival for the advanced bladder cancer population,” Feld said.