Summary Background The incidence of cancer is higher in men than in women at most shared anatomical sites for currently unknown reasons. The authors quantified the extent to which behaviors (smoking and alcohol consumption), anthropometry (body mass index and height), lifestyles (physical activity, diet, medications), and medical history collectively explain the male predominance of risk. in 21 shared cancer sites. Methods Prospective cohort analysis (n = 171,274 male and n = 122,826 female participants; age range, 50–71 years) in the National Institutes of Health-AARP Diet and Health Study (1995–2011). Cancer-specific Cox regression models were used to estimate male-to-female hazard ratios (HR). The degree to which risk factors explained the observed risk disparity between men and women was quantified using the Peters-Belson method . Results There were 26,693 incident cancers (17,951 in men and 8742 in women). The incidence was significantly lower in men than in women only for thyroid and gallbladder cancers. At most other anatomical sites, risks were higher in men than women (adjusted HR range, 1.3–10.8), with the strongest increases for bladder cancer (HR, 3.0–10.8). 33; 95% confidence interval [CI], 2.93–3.79), gastric cardia cancer (HR, 3.49; 95% CI, 2.26–5.37), laryngeal cancer (HR, , 3.53; 95% CI, 2.46–5.06) and esophageal adenocarcinoma (HR, 10.80; 95% CI, 7.33–15.90). Risk factors explained a statistically significant proportion (non-zero) of the male excess observed for esophageal adenocarcinoma and cancers of the liver, other bile ducts, bladder, skin, colon, rectum, and lung. However, only a modest proportion of the male excess was explained by risk factors (ranging from 50% for lung cancer to 11% for esophageal adenocarcinoma). Conclusions Men have a higher risk of cancer than women at most shared anatomical sites. This male predominance is largely unexplained by risk factors, underscoring the role of sex-related biological factors. |
Comments
Rates of most types of cancer are higher in men than women for reasons that are unclear. Results from a recent study published online in CANCER , a peer-reviewed journal of the American Cancer Society, suggest that underlying biological sex differences rather than behavioral differences related to smoking, drug use may be the cause. alcohol, diet and other factors.
Understanding the reasons for sex differences in cancer risk could provide important information to improve prevention and treatment. To investigate, Sarah S. Jackson, PhD, of the National Cancer Institute, part of the National Institutes of Health, and colleagues evaluated differences in cancer risk for each of 21 cancer sites among 171,274 men and 122,826 adult women ages 50 to 71 who participated in the NIH-AARP Diet and Health study between 1995 and 2011.
During that time, 17,951 new cancers emerged in men and 8,742 in women. Incidence was lower in men than women only for thyroid and gallbladder cancers, and risks were 1.3 to 10.8 times higher in men than women at other anatomic sites. The greatest increased risks in men were seen in cancer of the esophagus (a 10.8-fold increased risk), larynx (a 3.5-fold increased risk), gastric cardia (a 3.5-fold increased risk), and bladder cancer ( a risk 3.3 times greater risk).
Men had a higher risk of most cancers, even after adjusting for a wide range of risk behaviors and cancer exposures. In fact, differences in risk behaviors and cancer exposures between the sexes accounted for only a modest proportion of the male predominance of most cancers (ranging from 11% for esophageal cancer to 50% for esophageal cancer). lung).
The findings suggest that biological differences between the sexes, such as physiological, immunological, genetic and other differences, play an important role in the cancer susceptibility of men versus women.
“Our results show that there are differences in cancer incidence that are not explained solely by environmental exposures. “This suggests that there are intrinsic biological differences between men and women that affect cancer susceptibility,” Dr. Jackson said.
An accompanying editorial discusses the study’s findings and notes that a multifaceted approach must be implemented to address sex disparities in cancer. “The strategic inclusion of sex as a biological variable should be applied throughout the entire cancer continuum, from risk prediction and primary cancer prevention, cancer detection and secondary prevention, to cancer treatment and patient management,” the authors wrote. “Examining and addressing sex disparities in cancer and other diseases is an ongoing quest. Bench-to-bedside translational studies that effectively transform existing research findings into clinical practice are a scalable and easily accessible means to achieve precision medicine and will mitigate, and ultimately can eradicate, sex disparities in cancer.” .
