Women with hematuria were less than half as likely as men with the same issue to be referred to a urologist for further tests, according to a new study. The findings may help explain why bladder cancer is often diagnosed at a later stage in women, and mortality rates are higher in female patients than in male patients. The study was shared during the American Urological Association (AUA) annual conference in Orlando, Florida.

Blood in the urine is often the first sign of bladder cancer. The AUA recommends that everyone older than 35 years with hematuria not due to a benign cause receive an evaluation that includes bladder cystoscopy as well as imaging of the urinary tract, usually with a CT scan.

For this study, investigators from Vanderbilt University in Nashville, Tennessee, reviewed the medical records of a random sample of 9,211 Medicare beneficiaries with hematuria diagnosed between January 2009 and June 2010.

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Only 17% of females with a diagnosis of hematuria from their primary care provider were referred to a urologist for a diagnostic work-up within 180 days, compared to 39% of men. Receipt of a complete evaluation did not differ by race.

“The data in the literature suggest that the misdiagnosis and treatment of hematuria in women as urinary tract infection is one of the main reasons [women] present with more advanced stage bladder cancer at diagnosis,” said the study’s presenter, Jeffrey Bassett, MD, MPH.

Some of the difference may be clinical decision-making by physicians who know that women are less likely to have bladder cancer than men. But principal investigator Daniel Barocas, MD, MPH, said the disparities suggest primary care physicians may need to be more vigilant.

“We are missing opportunities to diagnose these cancers early enough and it’s increasing the treatment burden and mortality for women. Because we see such advanced disease in women and they are worked up for hematuria so much less frequently, there may be a need to figure out how to risk-stratify women to know whether or not they need a workup,” said Barocas.