Ethnicity and Race As Modifiers of the Association Between Patient Sex and Stage at Diagnosis of Bladder Cancer
Abstract
Introduction and Objective. In 2023, approximately 82,290 people will receive a bladder cancer diagnosis and about 16,710 patients will die from this disease, making bladder cancer the 10th leading cause of cancer related death in the U.S. Identifying high risk populations is essential for early detection and treatment of primary bladder malignancies as currently, there is no standard or routine screening test for bladder cancer in the United States. This study aimed to investigate whether race and ethnicity modifies the association between sex and stage at diagnosis in adults 18 years and older with primary bladder cancer diagnosed between 2000 and 2019. Methods. The NCI Surveillance, Epidemiology, and End Results (SEER) database was used to complete a cross-sectional study of 235,586 patients. The inclusion criteria consisted of patients 18 years and older diagnosed with a primary bladder malignancy reported to the SEER database from 2000 to 2019. Those patients missing data regarding race, ethnicity, sex, stage of cancer at diagnosis and covariates relevant to this study were excluded. The exposure variable was defined as sex and the primary outcome was stage at diagnosis. Covariates include age, year, tumor grade, household income, rural/urban denomination, primary site, and histological type. An unadjusted and adjusted multinomial logistic regression analysis was performed to estimate the association between sex and stage at diagnosis. Additionally, effect modification was explored by including the interaction term between the exposure variable and race and ethnicity in the model. Results. Our data revealed that ethnicity and race were effect modifiers of the association between sex and stage at diagnosis of primary bladder cancer. There was a 75% (95% CI 1.65-1.86) increased relative risk ratio (RRR) of Distant vs. In-Situ cancer staging among Non-Hispanic White (NHW) women. There was a 78% (RRR 1.78; 95% CI 1.53-2.07) increased RRR and 96% (RRR 1.96; 95% CI 1.64-2.33) increased relative risk for Regional vs In-Situ and Distant vs In-Situ respectively for Non-Hispanic Black (NHB) women. There was a 60% (RRR 1.6; 95% CI 1.38-1.87) increase in relative risk for Hispanic women among the Regional vs In-Situ group and an 86% (95% CI 1.56-2.22) increase in relative risk among Hispanic women among the Distant vs In-Situ cancer staging. Conclusions-Implications. With our research findings we hope to guide prevention screening and public health guidelines to target high-risk populations, help diagnosis, and treat bladder cancer in these patients at an earlier stage. This includes non-invasive screening test options such as point-of-care proteomic testing, genomic urine testing, and urine cytology exams with enhanced bladder cancer urinary biomarkers. Future studies may investigate the influence of risk factors such as smoking status on this association between race and ethnicity, and stage at diagnosis of bladder cancer.
Keywords
Bladder cancer, Race, Ethnicity, SEER database, Health disparities
Presentation Type
Poster Presentation
Ethnicity and Race As Modifiers of the Association Between Patient Sex and Stage at Diagnosis of Bladder Cancer
Introduction and Objective. In 2023, approximately 82,290 people will receive a bladder cancer diagnosis and about 16,710 patients will die from this disease, making bladder cancer the 10th leading cause of cancer related death in the U.S. Identifying high risk populations is essential for early detection and treatment of primary bladder malignancies as currently, there is no standard or routine screening test for bladder cancer in the United States. This study aimed to investigate whether race and ethnicity modifies the association between sex and stage at diagnosis in adults 18 years and older with primary bladder cancer diagnosed between 2000 and 2019. Methods. The NCI Surveillance, Epidemiology, and End Results (SEER) database was used to complete a cross-sectional study of 235,586 patients. The inclusion criteria consisted of patients 18 years and older diagnosed with a primary bladder malignancy reported to the SEER database from 2000 to 2019. Those patients missing data regarding race, ethnicity, sex, stage of cancer at diagnosis and covariates relevant to this study were excluded. The exposure variable was defined as sex and the primary outcome was stage at diagnosis. Covariates include age, year, tumor grade, household income, rural/urban denomination, primary site, and histological type. An unadjusted and adjusted multinomial logistic regression analysis was performed to estimate the association between sex and stage at diagnosis. Additionally, effect modification was explored by including the interaction term between the exposure variable and race and ethnicity in the model. Results. Our data revealed that ethnicity and race were effect modifiers of the association between sex and stage at diagnosis of primary bladder cancer. There was a 75% (95% CI 1.65-1.86) increased relative risk ratio (RRR) of Distant vs. In-Situ cancer staging among Non-Hispanic White (NHW) women. There was a 78% (RRR 1.78; 95% CI 1.53-2.07) increased RRR and 96% (RRR 1.96; 95% CI 1.64-2.33) increased relative risk for Regional vs In-Situ and Distant vs In-Situ respectively for Non-Hispanic Black (NHB) women. There was a 60% (RRR 1.6; 95% CI 1.38-1.87) increase in relative risk for Hispanic women among the Regional vs In-Situ group and an 86% (95% CI 1.56-2.22) increase in relative risk among Hispanic women among the Distant vs In-Situ cancer staging. Conclusions-Implications. With our research findings we hope to guide prevention screening and public health guidelines to target high-risk populations, help diagnosis, and treat bladder cancer in these patients at an earlier stage. This includes non-invasive screening test options such as point-of-care proteomic testing, genomic urine testing, and urine cytology exams with enhanced bladder cancer urinary biomarkers. Future studies may investigate the influence of risk factors such as smoking status on this association between race and ethnicity, and stage at diagnosis of bladder cancer.