Women with bladder cancer: an underserved population due to a faulty health care system or in a biological disadvantage?

Abstract

Abstract Although men are four times more frequently diagnosed than women with urothelial bladder cancer, clinical outcomes greatly differ between both genders, as women present a higher lethality rate, as well as a greater loss of life expectancy. At diagnosis, women present more advanced clinical stages, situation which has led to many efforts to elucidate the social determinants of health and the biological factors implied. Women face different challenges associated with a delay in both, diagnosis and treatment, a more limited access to systemic treatment, and lower response rates associated with immunotherapy. Women are underrepresented in the main chemotherapy, immunotherapy, and other systemic treatment trials, as they comprise only 15 to 25% of the overall population, limiting the possibility of drawing any definitive conclusions. Furthermore, through gene expression analysis, women have been linked to a more aggressive biological subtype of bladder cancer (basal), a higher rate of FGFR 1-4 mutated tumors, lower rate of NECTIN-4 expression, and a higher prevalence of germline mutations. Despite the worse prognosis, sex-based recommendations have not been developed. Cancer care teams must not hinder access to treatment options based on sex and should strive for an equitable cancer care.