Urologist Referral Delay and Survival after Bladder Cancer Surgery

Each year, approximately 390,000 people worldwide are diagnosed with bladder cancer1. The disease is the 2nd most common urologic cancer and the 5th most frequently diagnosed malignancy in Canada2. Unlike superficial bladder cancer, muscle-invasive disease is often treated with surgical removal of the bladder (radical cystectomy)3. Even though it is well accepted that treatment should be instituted once a diagnosis of bladder cancer has been made, there is growing evidence that preoperative wait times for cancer surgery have been increasing4,5. In addition, it has been suggested that delaying radical cystectomy for bladder cancer is associated with poorer survival6,7. Limited studies on the effect of sex in the continuum of health care for cancer suggest that urinary tract malignancies might be diagnosed less promptly in women than in men8. Although bladder cancer occurs with a higher incidence in men than in women, women tend to present with more advanced disease9. Moreover, women with bladder cancer are more likely than men to have pre-referral consultations with a general practitioner (gp) or a gynecologist and to experience a longer wait time between first symptoms and urologist referral10. Those sex differences indicate that gps might interpret the clinical importance of first symptoms of bladder cancer differently in women, potentially attributing them to other causes, such as urinary tract infections. ABSTRACT