A 76 year old woman reports recurrent urinary frequency, dysuria, and malodorous urine. No bacterial growth has been identified on two midstream urine samples, though empirical treatment with antibiotics has improved her symptoms. After three months, an episode of visible haematuria prompts referral and a transitional cell carcinoma of the bladder is diagnosed. In developed countries 90% of bladder cancers are transitional cell carcinomas; squamous cell carcinomas (SCC) make up most of the remainder.1 2 In endemic areas, squamous cell carcinoma related to schistosomiasis accounts for 70% of cases.1 Around 20% are muscle invasive at diagnosis and are associated with a significantly poorer prognosis.3 The major risk factor is smoking, though chronic infection, radiotherapy, and (before regulation) industrial dyes have been implicated.2 4 #### How common is bladder cancer in women? Although bladder cancer is more common in men, women experience more delays: the English National Audit of Cancer Diagnosis in Primary Care (2009-10) estimated that annually 435 more women than men with bladder cancer experience a delay in diagnosis, but there are few data from UK primary care to explain this.6 With no effective screening tool for bladder cancer, it is usually diagnosed symptomatically, with haematuria being the most common presenting symptom for both sexes in primary care (likelihood ratio 59, 95% confidence interval 51 to 57).3 7 The likelihood ratio summarises how many times more (or less) likely …