Sex Differences in Cancer Incidence and Survival: A Pan-Cancer Analysis

Background: Sex plays an important role in the incidence, prognosis, and mortality of cancers, but often is not considered in disease treatment. Methods: We quantified sex differences in cancer incidence using the USCS public use database and sex differences in cancer survival using SEER public use data from 2001 to 2016. Age-adjusted male-to-female incidence rate ratios with 95% CIs were generated by primary cancer site, race, and age groups. Additionally, age-adjusted hazard ratios with 95% CI by sex within site were generated. Results: In general, cancer incidence and overall survival was lower in males than females, with Kaposi sarcoma (IRR: 9.751, 95% CI: 9.287-10.242, p<0.001) having highest male-to-female incidence, and thyroid cancers (HR: 1.774; 95% CI: 1.707-1.845) having largest male-to-female survival difference. Asian or Pacific Islanders had particularly high male-to-female incidence in larynx cancers (IRR: 8.199; 95% CI: 7.203-9.363; p<0.001), relative to other races. Among primary brain tumors, germ cell tumors had the largest male-to-female incidence (IRR: 3.03; 95% CI: 2.798-3.284, p<0.001). Conclusions: Overall, incidence and survival of cancer vary significantly by sex, with males generally having lower incidence and survival compared to females. Male-to-female incidence differences were also noted across race and age groups. These results provide strong evidence that the fundamental biology of sex differences affects cancers of all types. Impact: This study represents the most recent and comprehensive reporting of sex differences in cancer incidence and survival in the United States. Identifying disadvantaged groups is critical as it can provide useful information to improve cancer survival, as well as to better understand the etiology and pathogenesis of specific cancers.



Work Title Sex Differences in Cancer Incidence and Survival: A Pan-Cancer Analysis
Open Access
  1. Michelle Dong
  2. Gino Cioffi
  3. Jacqueline Wang
  4. Kristin A Waite
  5. Quinn T Ostrom
  6. Carol Kruchko
  7. Justin Lathia
  8. Joshua B. Rubin
  9. Michael E. Berens
  10. James R. Connor
  11. Jill S. Barnholtz-Sloan
  1. survival
  2. incidence
  3. sex-differences
License In Copyright (Rights Reserved)
Work Type Article
  1. Cancer Epidemiology, Biomarkers & Prevention
Publication Date July 2020
Publisher Identifier (DOI)
  1. 10.1158/1055-9965.EPI-20-0036
Deposited March 16, 2021




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Work History

Version 1

  • Created
  • Added Creator Michelle Dong
  • Added Creator Gino Cioffi
  • Added Creator Jacqueline Wang
  • Added Creator Kristin A Waite
  • Added Creator Quinn T Ostrom
  • Added Creator Carol Kruchko
  • Added Creator Justin Lathia
  • Added Creator Joshua B. Rubin
  • Added Creator Michael E. Berens
  • Added Creator James Robert Connor
  • Added Creator Jill S. Barnholtz-Sloan
  • Added Sex_Differences_CEBP_Update_Final_CLEAN_Reformatted.docx
  • Updated License Show Changes
  • Published
  • Renamed Creator James R. Connor Show Changes
    • James Robert Connor
    • James R. Connor
  • Updated