Disparities in Genitourinary Cancers Incidence and Mortality in the United States - Expert Commentary
The authors collected data on the incidence and mortality of genitourinary cancers from the Surveillance, Epidemiology, and End Results (SEER) database and the U.S. Cancer Statistics database. Incidence and mortality rates for kidney and bladder cancers were two-fold to four-fold higher among men than women. Bladder cancer incidence was highest among White patients, while mortality was highest among White and Black women. Incidence rates for kidney and testicular cancers were highest among non-Hispanic American Indian and Alaska Natives (AIAN). Black men had the lowest incidence rates of testicular cancer, while non-Hispanic Asian American and Pacific Islanders (AAPI) had the lowest rates of kidney cancer. Black men had the highest incidence of prostate cancer and mortality rates from this disease.
A geographical analysis of incidence and mortality by county revealed that the highest incidence rates for White individuals were in the Northeast for bladder cancer and in Appalachia and the South for kidney cancer. Prostate cancer incidence was highest in the North and Southeast, while the highest mortality rates were in the West. Overall, incidence and mortality rates for bladder cancer have decreased across all demographics except among AIAN individuals (increasing) and AAPI men and Hispanic women. In contrast, the overall incidence rates for kidney and testicular cancers increased between 2000 and 2019, except for the incidence of kidney cancer among AAPI men and Black women. Between 1990 and 2020, kidney cancer mortality rates decreased across populations, while those associated with testicular cancer decreased among White males. Incidence rates for prostate cancer exhibited a sharp decrease between the late 2000s and early 2010s, followed by an increase in recent years.
This study reveals important sociodemographic disparities in differences in incidence and mortality rates of genitourinary cancers. Cigarette smoking and other risk factors do not explain the significant difference in incidence rates between men and women and between White and Black men. This may indicate differences associated with demographic characteristics, such as access to care. Moreover, the stark differences in patterns across different geographical regions may point toward environmental factors such as polluted water. The positive finding of decreased death rates for all major genitourinary cancers may result from enhanced detection and screening, a reduction in cigarette smoking, and treatment developments. However, these associations and any potential causes for observed trends would require further validation through studies focused on specific disparities or environmental exposures.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
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