Urothelial cancer prognosis worse for smokers, particularly women

Risk of developing serious forms of urothelial carcinoma is significantly increased in smokers and leads to a higher likelihood of dying from the disease, especially for women. While the biological mechanisms underlying this gender difference are unknown, the findings indicate that clinicians and society in general should focus on smoking prevention and cessation to safeguard against deadly cancers of the bladder, ureters, and renal pelvis, particularly in women.

To evaluate the gender-specific effects of smoking habits and cumulative smoking exposure on the health of patients with urothelial carcinoma, investigators led by Shahrokh Shariat, MD, of the Weill Medical College of Cornell University and New York-Presbyterian Hospital in New York City, studied 864 patients (553 men and 311 women) from five international institutions who underwent surgery to treat urothelial carcinoma.

Cancer was more likely to recur in female current smokers than in male current smokers. In heavy long-term smokers, women were 70% more likely to experience a cancer recurrence and twice as likely to die from cancer as men. In female patients only, cancer recurrence and death were linked with smoking quantity, duration, and cumulative exposure. For both men and women, those who stopped smoking for more than 10 years saw their risk of dying from cancer revert to that of nonsmokers.

"The biological and clinical effect of smoking seems to be different in females than in males. More effort needs to be spent on the science of how normal human biology differs between men and women and how the diagnosis and treatment of urothelial carcinoma differs as a function of gender," said Shariat. "Also, gender-specific smoking prevention and cessation can have a major health care impact in urothelial carcinoma."

This study was recently published in BJU International (2013; doi:10.1111/bju.12014).

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