Frequent Infections May Lead to Delayed Cancer Diagnoses in Women

Women tend to experience urinary tract infections (UTIs) more frequently than men. However, this could lead to a delay in diagnosis when it comes to screening for bladder and kidney cancer, according to research presented at the Cancer Research UK Early Diagnosis Conference in Birmingham, UK.

Early diagnosis is key to a good prognosis in patients with urological cancers. While new diagnostic tools like a urine test that detects tumor DNA could improve screening methods for bladder cancer in the future, researchers say that current sub-optimal diagnostic practices deserve a closer look.

In an interview with CURE, lead researcher Yin Zhou, MBBS, MSc, MRCGP, a clinical research fellow at the University of Cambridge, explained how the quality and timeliness of cancer screening impacts patients — and what is being done to improve the process.

CURE: What prompted this research?

Zhou: Essentially, prior work in the area of bladder and kidney cancer found quite a big survival difference between men and women. So, what we wanted to know was whether we are doing something different in men versus women during the diagnostic process that's contributing to the survival difference.

In bladder cancer, women tend to have a worse prognosis, and worse survival at five years compared to men, even if they're diagnosed at the same stage. We don't quite know why that is; it may be something biological, but we wanted to know whether there's something different in how they present and how clinicians are investigating their symptoms and if that's contributing to this (disparity). We wanted to know what's happening during the diagnostic process. How are we evaluating these patients with these symptoms and what other things affect the quality of the diagnostic process?

Can you explain how the data analysis was performed?

The analysis was performed by searching for keywords relating to our topics in two international medical journal databases (Medline and Embase). From the more than 8,000 papers, we then screened their titles and abstracts for relevance and ended up with 24 papers. The analysis was in extracting the data that we're interested in from these 24 papers and trying to draw new conclusions based on the consistent evidence.

And what conclusions did you find?

There were quite a few, but essentially, we found a difference in terms of how timely women are evaluated for kidney and bladder cancer and that they do a little bit worse than men.

Women with blood in their urine tend to have a worse or longer time to evaluation than men and they tend to be treated for their symptoms more than men. So, instead of being referred on, they're more likely to be treated by the clinician rather than investigated. If a man comes in, he's more likely to be referred on and investigated, whereas women are more likely to be given a treatment of some sort and then sent away.

Additionally, women are more likely to be treated multiple times before their diagnosis. They're more likely to have three or more UTIs being treated before a cancer diagnosis, where men might get one UTI before they're investigated on the second UTI. So, there is a little bit of a discrepancy in how we're evaluating these patients.

UTIs are quite common in women, so that makes it a little bit harder; clinically, we're expecting women to get more UTIs, so we treat them. But at what point should we be thinking about whether this patient needs further investigation?

Can you elaborate on why it is important that patients with frequent UTIs follow up with their doctors after the initial diagnosis?

The symptoms of UTI and possible cancer do overlap, so that's what we're really trying to tell people. A UTI may be an initial sign or symptom of bladder cancer, and so those people with frequent UTIs, especially if they're in a higher-risk group, i.e. if they are older or a smoker, then they should be wary of if there is something driving these symptoms in the background. Don't just assume it's another UTI.

Generally, three or more UTIs in a year (or two or more in six months) is classed as "recurrent." The risk for cancer is small, but it's trying to put it together with your other risk factors.

What next steps will be taken as a result of these findings?

We've got a study that's looking at national data within the UK and how general practitioners or primary care clinicians are evaluating and diagnosing patients with symptoms of kidney and bladder cancers. That's one part of my research, and another part is using Big Data to understand the diagnostic process.

Finally, another part is going out to the practices and interviewing patients and general practitioners and finding out how they present, how they're investigated and what might be the barriers to investigating or coming to a clinician. It's all about improving the diagnostic process and trying to catch these two cancers earlier.