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Rates of Undiagnosed Bladder Cancer in Women Due to Misdiagnosis as Urinary Tract Infection

12 August 2016


Background: Bladder cancer is the seventh-leading cause of cancer-related deaths in the US. Presenting signs include hematuria and irritative voiding symptoms including dysuria and frequency. Formal evaluation includes cystoscopy, upper tract imaging, cytology, and urine culture. There is no agreed upon screening guideline for bladder cancer between the American Urological Association (AUA) and USPSTF. Primary care providers bear the burden of making the decision when to refer and when to treat in the primary setting. Many bladder cancers are diagnosed later due to the masking symptoms of UTI, especially in women, resulting in a delayed diagnosis of cancer, and a later stage of cancer limiting treatment options.

Methods: An exhaustive search of online medical literature was performed using MEDLINE-PubMed, Web of Science, Google Scholar, and CINAHL-EBSCO. Keywords used included: bladder cancer, urinary tract infection, hematuria, primary care, and gender disparities. Eligible studies were assessed using the GRADE criteria.

Results: A total of one hundred sixty seven articles were reviewed, eleven articles read in their entirety, and two articles met inclusion criteria and were analyzed using the GRADE guidelines. Both studies were retrospective cohort studies and showed that a delay in diagnosis of bladder cancer is concealed by symptoms resembling urinary tract infections, especially in women. The overall quality of the studies is very low due to observational studies. Further studies need to be conducted to improve quality of evidence in regards to the effects of delayed diagnosis and laxity in following guidelines.

Conclusion: Delaying referral and formal evaluation for the source of urinary tract infections and hematuria in the primary care setting is delaying the diagnosis of bladder cancer, especially in women. Strict adherence to the AUA guidelines needs to be followed for referral and evaluation for the source of the irritative symptoms.


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