ATLANTA — Women with a new or a recurrent episode of hematuria are significantly less likely to be referred to a specialist for follow-up than are men with the same condition, researchers said at the annual meeting of the American Urological Association.
This delay in referral may be putting women at greater risk of death from bladder cancer, said Dr. Cheryl T. Lee, director of the Bladder Cancer Research Program at the University of Michigan in Ann Arbor.
Using insurance records from a nonprofit health plan, Dr. Lee and her colleagues performed a retrospective cohort study of 926 patients (60% men, 40% women) aged 18 years and older, who had new diagnosis codes for hematuria.
The investigators reported that 402 of 559 men (72%) were referred for urologic evaluation of hematuria, compared with 102 of 367 women (28%) over follow-up periods of 27 and 26 months, respectively. This gender disparity in referral was greatest in women over the age of 60, in whom bladder cancer is more common. “This unequal access to specialty evaluation of hematuria could potentially contribute to the delay in diagnosis of bladder cancer we so frequently see in women,” she said.
Men were significantly more likely to be referred to a specialist upon first presentation to a general practitioner with hematuria, compared with women, who were not referred until their second or third episode. This bias was stronger as patients aged, with men being referred at higher rates than women in the 50- to 59-year-old age category and the over-60 age category.
Ultimately, an adjusted multivariate analysis showed that men were 65% more likely to undergo urologic evaluation of hematuria than were women, Dr. Lee said.
Blood in the urine from urinary tract infections occurs more commonly in women than in men but generally in women under the age of 40, she commented. “I would argue that women in their 50s are at risk for bladder cancer, but certainly there is no argument about the increasing risk for women over the age of 60. An alarm should really go off when you see these women in your practice,” she said in an interview.
She conceded that the low prevalence of bladder cancer overall makes it difficult for the primary care physician to know when to refer.
The gender disparity in referral was greatest in women over the age of 60. DR. LEE