title: Impact of gender on bladder cancer incidence, staging, and prognosis.
abstract: BACKGROUND
  While patient gender is an important factor in the clinical decision-making for the management of bladder cancer, there are minimal evidence-based recommendations to guide health care professionals. Recent epidemiologic and translational research has shed some light on the complex relationship between gender and bladder cancer. Our aim was to review the literature on the effect of gender on bladder cancer incidence, biology, mortality, and treatment.
  
  
  METHODS
  Using MEDLINE, we performed a search of the literature between January 1975 and April 2011.
  
  
  RESULTS
  Although men are nearly 3-4 times more likely to develop bladder cancer than women, women present with more advanced disease and have worse survival. Recently, a number of population-based and multicenter collaborative studies have shown that female gender is associated with a significantly higher rate of cancer-specific recurrence and mortality after radical cystectomy. The disparity between genders is proposed to be the result of a differences exposure to carcinogens (i.e., tobacco and chemicals) as well as reflective of genetic, anatomic, hormonal, societal, and environmental factors. Explanations for the differential behavior of bladder cancer between genders include sex steroids and their receptors as well as inferior quality of care for women (inpatient length of stay, referral patterns, and surgical outcomes).
  
  
  CONCLUSIONS
  It is imperative that health care practitioners and researchers from disparate disciplines collectively focus efforts to appropriately develop gender-specific evidence-based guidelines for bladder cancer patients. We must strive to develop multidisciplinary collaborative efforts to provide tailored gender-specific care for bladder cancer patients.
authors.affiliation: Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. harun.fajkovic@gmail.com
authors.forename: Harun
authors.initials: H
authors.lastname: Fajkovic
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Halpern
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Cha
authors.forename: Atessa
authors.initials: A
authors.lastname: Bahadori
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Eckart
authors.initials: E
authors.lastname: Breinl
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012727:Sex Characteristics; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D019459:Urothelium / Q000473:pathology