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Bladder Cancer in Women from Deprived Areas: Impact on Survival

Study from North Western Cancer Registry explores why women in deprived areas have worse bladder cancer survival, presenting later stages. Results show a significant correlation. Published in British Journal of Cancer, 2004.

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Bladder Cancer in Women from Deprived Areas: Impact on Survival

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  1. NORTH WESTERN CANCER REGISTRY Introduction BLADDER CANCER: Later stage and worsesurvival in women from deprived areas British Journal of Cancer (2004) 90, 2142-2144 North WesternCancer Registry T.Moran A-M Sowerbutts Stuart Collins R Hartley D.Chandler Christie Hospital NHS Trust N.Clarke R.Cowan

  2. NORTH WESTERN CANCER REGISTRY Background • Bladder is the only common cancer for which women have a worse survival than men • Largest gap at one year • Some evidence that women are more likely to present with later stage disease Aim of study: To determine why women have a worse prognosis than men: a) Do women present later? b) Is social deprivation a factor?

  3. NORTH WESTERN CANCER REGISTRY Criteria for study subjects • Resident of Greater Manchester, Lancashire and South Cumbria • Muscle-invasive tumour diagnosed in 1998 (MID) • No history of bladder cancer

  4. NORTH WESTERN CANCER REGISTRY Methods I • 1190 Patients with bladder tumours identified from North Western Cancer Registry database • Pathology reports reviewed to identify those with histologically verified muscle-invasive disease • Case notes requested on: (i) Those with histologically verified MID (ii) Those who underwent cystectomy or radiotherapy (iii) Those who died within 3 years of diagnosis • 90% reviewed

  5. NORTH WESTERN CANCER REGISTRY Methods II Deaths classified into those due to bladder cancer and to other causes Stage classified into advanced (T4b and/or M1) and non-advanced Deprivation measured using the Townsend Score

  6. NORTH WESTERN CANCER REGISTRY Statistics • Frequency distribution • 2 and t-tests • Survival • Kaplan-Meier • Log-Rank test

  7. NORTH WESTERN CANCER REGISTRY Characteristics of Study Population (347) Median Age Male 227 (65.5%) 72.5 Female 120 (34.5%) 75.5

  8. NORTH WESTERN CANCER REGISTRY Difference in cause-specificsurvival by sex Time Difference(Months) 3 10.9% 6 19.9%* 12 15.8% 36 9.9% 49 women and 48 men died from bladder cancer in the first six months * Log-Rank 2 = 14.7; 1 df; p<0.01

  9. NORTH WESTERN CANCER REGISTRY Advanced stage at diagnosis Male 33(14.5%) Female 35 (29.2%) (2 = 10.7; 1 df; p<0.01)

  10. NORTH WESTERN CANCER REGISTRY Number (%) with advanced disease by deprivation quintiles Quintile Male Female 1 8 (17.8%) 3 (15.8%) 2 5 (11.9%) 0 ( 0.0%) 3 4 (12.1%) 9 (31.0%) 4 7 (11.9%) 9 (36.0%) 5 9 (18.8%) 14 (43.8%) Total 33 (14.5%) 35 (29.2%)

  11. NORTH WESTERN CANCER REGISTRY Six-month survival ratesby deprivation quintiles Survival Rate (%) Quintile More deprived

  12. NORTH WESTERN CANCER REGISTRY Survival and stage by two deprivationcategories for females Number (%) with Six-Month Survival Advanced Disease Quintiles 3 (8.8%) 73.5% 1+2 Quintiles 32 (37.5%) 52.3% 3+4+5 More deprived Worse (2 = 4.8; 1 df; p<0.05) (2 = 9.5; 1 df; p<0.01)

  13. NORTH WESTERN CANCER REGISTRY Conclusion Women from more deprived backgrounds present with later stage disease and have a worse prognosis than either men or women from less deprived neighbourhoods.

  14. NORTH WESTERN CANCER REGISTRY BLADDER CANCER: Later stage and worsesurvival in women from deprived areas British Journal of Cancer (2004) 90, 2142-2144 North WesternCancer Registry T.Moran A-M Sowerbutts Stuart Collins R Hartley D.Chandler Christie Hospital NHS Trust N.Clarke R.Cowan

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