White Americans have a two-fold higher incidence of bladder cancer than black Americans, but the risk of death among blacks is 35 percent higher than whites when patients with the same cancer stage and grade are compared.

These are the observations of Dr. Cheryl T. Lee and colleagues at the University of Michigan at Ann Arbor, who examined trends in tumor discovery, treatment and survival among 93,093 patients -- 89,491 whites and 3,612 blacks -- with bladder cancer. The observation period began in 1973 and ended in 1999, divided into 5-year intervals. The average follow-up time per patient was 10 years.

Data analysis showed that bladder cancer is diagnosed at more advanced stages among blacks, especially black women.

Overall, at the time of first diagnosis, 79 percent of white patients had "localized" disease, 18 percent had "regionalized" disease and 3 percent had "metastatic" (extensively spread) bladder cancer. For blacks, 67 percent had localized disease, 26 percent had regionalized disease and 6 percent had metastatic disease at diagnosis.

Ten-year disease-specific survival rates were 81 percent for blacks and 88 percent for whites with localized disease. There was a similar disparity for regional and distant disease, and when cancers were stratified by stage and grade.

The risk of dying from bladder cancer was 35 percent higher among blacks compared with whites.

Lee believes that many factors may explain the reason for poorer survival in blacks compared with whites. "We did not study any genetic susceptibilities, but there are clearly other issues involved other than tumor stage and grade," she told Reuters Health.

In the study, published in the Journal of Urology, Lee points out that the disparity for black women, in particular, is worrisome, because while the overall trend in recent years is toward lower grades and stages at the time of diagnosis and improved survival, this is not seen in black women.

"The findings provide rationale to study several aspects of treatment decision making and patient management," Lee commented, "in addition to directing education programs at the black community focused on black women."

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