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Bladder cancer in women

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Bladder cancer is often thought of as affecting men, and with good reason. New cases of this cancer are more than three times higher among men. But this doesn’t mean bladder cancer is not a cause for concern in women.

“Even though men are more commonly diagnosed with bladder cancer, women are often diagnosed with more advanced disease and they have worse survival than men,” says Mark D. Tyson II, M.D., M.P.H., a urologist at Mayo Clinic’s campus in Arizona. He spoke on the topic during a recent Mayo Clinic Q&A podcast.

One reason for this disparity may be that in women, it’s easy to confuse signs and symptoms of bladder cancer — including blood in the urine (hematuria) — with other conditions or to attribute them to sources other than a serious disease. There are many reasons for hematuria in women, such as urinary tract infections and postmenopausal bleeding. Women experiencing bleeding may just assume they are bleeding for one of these more innocuous reasons and ignore it.

But ignoring symptoms can lead to a delay in evaluation and care. If the cause of bleeding is bladder cancer, the result could be more advanced disease at diagnosis.

Not only do women have worse survival than men, but certain women of color have worse survival rates than white women. A 2018 study found the five-year survival rate among Black women with urinary bladder cancer was 53% — the lowest of any racial or ethnic group —compared with 74% in white women. Hispanic women had a five-year survival rate of 69%.

“We know that there are some racial and ethnic disparities,” says Dr. Tyson. “Hispanics do worse than non-Hispanics in terms of survival. African-American men and women have a higher mortality risk, particularly in that late-stage disease group.”

In light of these outcomes, Dr. Tyson emphasizes that visible blood (gross hematuria) requires medical attention. The good news is that visible blood could still be harmless, and a red color in urine may not be blood.

Benign and serious causes of hematuria

Some medications and certain foods, such as berries, rhubarb and beets, can turn urine red. Red blood cells can make urine red, pink or cola colored.

Reasons other than bladder cancer for blood in the urine include:

  • Recent vigorous exercise
  • Menstruation
  • Sexual activity
  • Kidney infection
  • Kidney stones or disease
  • Injury to a kidney
  • Sickle cell anemia

Getting to the root cause

If you’re urine appears red, pink or cola colored, make an appointment to see your health care provider. Your health care provider typically reviews your diet, medications and medical history first. Then you may have a pelvic exam to check your vagina for issues that could have led to vaginal bleeding.

The first laboratory test you have is likely a dipstick on your urine to look for RBCs. It may need to be repeated if you are menstruating. That’s because menstrual blood in your urine sample could give a false-positive dipstick result. To check your kidney health, you may have a blood test.

If your dipstick results are a true positive, your urine is sent for a urinalysis. In a urinalysis, a technician looks for different kinds of cells that signal a health problem.

Your health care provider may want you to have a cystoscopy if there’s blood in your urine and you’re at risk of or have problems with your kidneys or urinary tract. In that procedure, a small tube with a camera in it is inserted into your urethra and up into your bladder.

It’s important to undergo these tests when you’re experiencing hematuria, because there is no widely used screening test for bladder cancer. Urinalysis is not used as a screening test because a lot of people have blood in their urine for reasons other than bladder cancer. There are some urinary biomarkers that show promise as a way to screen for bladder cancer, but these are not yet validated, says Dr. Tyson.

Mark D. Tyson II, M.D.

Mark D. Tyson II, M.D., is a urologic oncologist, with subspecialty interest in bladder cancer, at Mayo Clinic in Scottsdale, Arizona. His clinical focus includes treatments for muscle invasive and nonmuscle invasive bladder cancer.

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