Men with cancer more often receive treatment aimed at healing or reducing the size of the tumor. In female cancer patients, the emphasis is more often on pain relief. That is one of the most striking conclusions a report from the Integrated Cancer Center of the Netherlands (IKNL) in which researchers made an initial inventory of male-female differences in cancer diagnosis, treatment, survival and quality of life.
It is the first time that male-female differences in cancer have been so clearly listed. Only in recent years has it become clear that there are major differences between men and women in cardiovascular diseases, including in the symptoms, but also in the underlying mechanisms. Little is known about many other diseases.
It was already known that certain types of cancer occur more often – or exclusively – in men, such as prostate cancer, and others more often (or only) in women, such as breast cancer. In the report, the researchers looked at the types of cancer that occur in both sexes. There they also saw a male-female difference. These cancers affect men slightly more often than women. Every year, more than 120,000 people in the Netherlands are diagnosed with cancer. Just over half of them, 65,000, are men.
However, that difference has become smaller since 1990, because the exposure to all kinds of risk factors has become more equal for men and women. For example, in recent decades the number of women who smoke has fallen less rapidly than the number of men.
Tumor-targeted treatment
The new analysis shows that sometimes the type of treatment also differs. For melanoma (a form of skin cancer), advanced stomach and esophageal cancer and metastatic colon cancer, women are less likely to receive treatment against the tumor, such as surgery, chemotherapy or radiation.
For example, 60 percent of women received tumor-targeted treatment against melanoma with metastasis, compared to 68 percent of men. This difference in melanoma treatment was even greater among people over 65: 46 percent of women compared to 60 percent of men.
Conversely, women under 55 with esophageal or metastatic pancreatic cancer receive such treatment more often than men (women 63 percent, men 54 percent). This did not differ with other cancer types.
Women over the age of 70 in particular receive supportive care more often. For colorectal cancer, 48 percent received no tumor-targeted treatment, compared to 40 percent of men. Why this is the case needs to be further investigated, the researchers write. Women may prefer this more often than men. Over the past ten years, the choice of treatment has become much more of a joint decision between a doctor and the patient.
Urethra
The differences in cancer between men and women can partly be explained by biological differences – such as in the hormone system and the immune system. Other factors also play a role. In women, for example, bladder cancer is often discovered later. This may be because women or doctors are not immediately alarmed if there is blood in their urine: bladder infections are much more common in women because their urethra is shorter than that of men. Because it is discovered later, survival from bladder cancer is worse for women than for men. Conversely, thyroid cancer is discovered later in men than in women.
On average, five years after diagnosis, 65 percent of men are still alive, compared to 71 percent of women.
With the first, and still incomplete, inventory, the IKNL wants to draw more attention to male-female differences in cancer among doctors, researchers and policy makers. They recommend, among other things, that more women be included in clinical studies and that the results of men and women in studies be analyzed separately as standard.
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