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

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 Background NORTH WESTERN CANCER REGISTRY Aim of study: To determine why women have a worse prognosis than men: a) Do women present later? b) Is social deprivation a factor?

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

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 Methods I NORTH WESTERN CANCER REGISTRY

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 Methods II NORTH WESTERN CANCER REGISTRY

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

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

Difference in cause-specific survival by sex Time Difference (Months) % %* % % 49 women and 48 men died from bladder cancer in the first six months * Log-Rank  2 = 14.7; 1 df; p<0.01 NORTH WESTERN CANCER REGISTRY

Advanced stage at diagnosis Male33(14.5%) Female35 (29.2%) (  2 = 10.7; 1 df; p<0.01) 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%) Total33 (14.5%)35 (29.2%) NORTH WESTERN CANCER REGISTRY

Six-month survival rates by deprivation quintiles NORTH WESTERN CANCER REGISTRY Survival Rate (%) More deprived Quintile

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

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

BLADDER CANCER: Later stage and worse survival in women from deprived areas British Journal of Cancer (2004) 90, North Western Cancer Registry T.Moran A-M Sowerbutts Stuart Collins R Hartley D.Chandler Christie Hospital NHS Trust N.Clarke R.Cowan