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, overal l survival is worse compared with American whites. This phenomenon has been attributed to the higher incidence of: advanced disease at diagnosis and p oor follow-up. Fifty-nine cases of bladder cancer were identified through t he Tumor Registry at Harlem Hospital and reviewed retrospectively. Complete data were obtained for 42 patients. The primary independent variables of i nterest were primary care utilization, comorbid conditions, social variable s, and gender. The outcome variables of interest were stage of disease at p resentation and death. The median age at diagnosis in this group was 73 yea rs compared with 68 for bladder cancer patients in the United States. There was no statistically significant correlation between primary care utilizat ion or severity of comorbidities, and clinical stage at presentation. Simil arly, these variables did not influence the occurrence of death as an outco me. 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 od ds 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 outcom e. The significantly elevated prevalence of smoking among women in this com munity, increased age at diagnosis, and possible environmental influences m ay play a role.