The influence of gender on incidence and outcome of patients with bladder cancer in Harlem

Although African Americans have a lower incidence of bladder cancer, overall survival is worse compared with American whites. This phenomenon has been attributed to the higher incidence of advanced disease at diagnosis and poor follow-up. Fifty-nine cases of bladder cancer were identified through the Tumor Registry at Harlem Hospital and reviewed retrospectively. Complete data were obtained for 42 patients. The primary independent variables of interest were primary care utilization, comorbid conditions, social variables, and gender. The outcome variables of interest were stage of disease at presentation and death. The median age at diagnosis in this group was 73 years compared with 68 for bladder cancer patients in the United States. There was no statistically significant correlation between primary care utilization or severity of comorbidities, and clinical stage at presentation. Similarly, these variables did not influence the occurrence of death as an outcome. For women, the mean age at diagnosis was 74.2 years compared with 67.3 in men (P = .112). The ratio of male-to-female cases in this group was 1.3 to 1 compared with 2.7 to 1 for the general US population. Women had lower odds of being diagnosed with superficial disease (OR = 0.24, 95% CI, 0.06-0.94) and a higher incidence of a cancer-specific death (OR = 2.7, 95% CI). The poor outcome and high incidence of bladder cancer cases among women in Harlem is intriguing. Overall, primary care utilization, comorbidities, and other social factors did not seem to influence stage or death as an outcome. The significantly elevated prevalence of smoking among women in this community, increased age at diagnosis, and possible environmental influences may play a role.