Bladder cancer - Race differences in extent of disease at diagnosis

BACKGROUND. Blacks are less likely than whites to develop bladder cancer; a lthough once diagnosed, blacks experience poorer survival. This study sough t to examine multiple biological and behavioral factors and their influence on extent of disease. METHODS. A population-based cohort of black bladder cancer patients and a r andom sample of frequency-matched white bladder cancer patients, stratified by age, gender, and race were identified through cancer registry systems i n metropolitan Atlanta, New Orleans, and the San Francisco/Oakland area. Pa tients were ages 20-79 years at bladder cancer diagnosis from 1985-1987, an d had no previous cancer history. Medical records were reviewed at initial diagnosis. Of the patients selected for study, a total of 77% of patients w as interviewed. Grade, stage, and other variables (including age, socioecon omic status, symptom duration, and smoking history) were recorded. Extent o f disease was modeled in 497 patients with urothelial carcinoma using logis tic regression. RESULTS. Extent of disease at diagnosis was significantly greater in Blacks than in Whites. Older age group, higher tumor grade, larger tumors, and pr esence of carcinoma in situ were related to greater extent of disease in bl acks and in whites. Large disparities between blacks and whites were found for socioeconomic status and source of care. Blacks had greater symptom dur ation and higher grade. Black women were more likely to have invasive disea se than white women; this difference was not seen among men. Blacks in unsk illed occupational categories, perhaps reflecting socioeconomic factors, we re at much higher risk for muscle invasion than whites. CONCLUSIONS. While specific relationships between variables were noted, an overall pattern defining black and white differences in stage did not emerg e. Future studies should examine the basis upon which occupation and life s tyle factors operate by using biochemical and molecular methods to study th e genetic factors involved. Published 2000 by the American Cancer Society.* .