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Enigmatic sex disparities in cancer incidence

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Abstract

In this study we aimed to identify cancers where there is a consistent sex disparity, with the goal of identifying unexplained sex disparities that may offer promising opportunities for etiologic research. Age- and sex-specific cancer incidence data from Cancer Incidence in Five Continents, provided by the International Agency for Research on Cancer, were used to calculate incidence rate ratios for 35 cancer sites, comparing men to women, adjusting for attained age, gross domestic product (GDP), and geographical region. Genital cancers and breast cancer were excluded. The consistency of relative risks was examined by GDP and geographical region and, in a subset of longstanding cancer registers, by calendar year. For each cancer site, the sex disparity was broadly classified as plausibly explained by established environmental risk factors, partly explained, or unexplained. Cancer incidence was statistically significantly higher in men than women at 32 of 35 sites, with disparities >2-fold for 15 sites and >4-fold for 5 sites. For nearly all sites, the sex disparity was consistent across GDP groups and geographical regions. However, the incidence rate ratios varied considerably by age at diagnosis. The sex disparity for 13 cancer sites was considered to be entirely unexplained by known risk factors; these sites showed strikingly little variation in the incidence rate ratios over decades. Thus, the basis of many of the largest sex disparities in cancer incidence seems mostly unknown, highlighting the need for intensified research into its origins.

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Acknowledgments

We thank Prof. Georg Klein and Dr. Min-Han Tan for their critical review of an earlier draft of this manuscript. All four authors contributed to the study design and drafting of the manuscript. Dr Edgren had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The final approval of the manuscript was performed by Drs Edgren and Chang. Dr Edgren has received funding through a post-doctoral stipend from Svenska Sällskapet för Medicinsk Forskning (SSMF). No other funding was obtained for this study.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77, Stockholm, Sweden

    Gustaf Edgren & Hans-Olov Adami

  2. Department of Epidemiology, Harvard School of Public Health, Boston, USA

    Gustaf Edgren, Liming Liang & Hans-Olov Adami

  3. Cancer Prevention Institute of California, Fremont, CA, USA

    Ellen T. Chang

  4. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA

    Ellen T. Chang

Authors
  1. Gustaf Edgren
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  2. Liming Liang
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  4. Ellen T. Chang
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Correspondence to Gustaf Edgren.

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Edgren, G., Liang, L., Adami, HO. et al. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol 27, 187–196 (2012). https://doi.org/10.1007/s10654-011-9647-5

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  • DOI: https://doi.org/10.1007/s10654-011-9647-5

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