Sex and gender based differences in the incidence and surgical management of cancer : a literature review

Abstract EN

Objectives: To study the impact of gender and sex on the incidence and management of malignant diseases.the period from 1985 to 2019 inclusive.

We studied the disparity related to sex and gender in the incidence, clinical presentation, response to surgical and chemotherapeutic treatment and the outcome in term of survival or mortality of malignant diseases.

This search yielded 325 articles, after independent manual review, 197potential articles were identified and fully reviewed, only 38 articles were included in this study, 128 articles were excluded.

Results: Gender and sex disparity in the incidence, presentation, aggressiveness, survival, mortality have been clearly noticed for a variety of cancers in both adults and children.

The incidence of fatal cases of malignancy, M:F ratio was 4:1 in respiratory tract, while it was 2:1 in oral cavity, tongue and urinary bladder.

In females; malignancy of breast, peritoneum, omentum, mesentery, thyroid, gallbladder, anus, anal canal, and anorectum had a higher incidence than in males.

Presentation disparity as in melanomas was more commonly noticed on the lower extremities in women while it was more often on the trunk and head and neck in men.

Male to female (M:F) cancer mortality rate in general was 1.46:1.0.

Sex differences in the response to chemotherapy and their side effects were noticed with an improved response in women.

Geographic distribution affects significantly male and female mortality in certain cancers such as pancreatic.

In childhood malignancy the prognosis was worse in boys than girls and the distribution of malignancy varies according to age subgroups.

Conclusions: Males; adults and children are more prone to develop cancer and have worse overall survival and higher mortality rates than females.

The significant survival advantage of women in several different cancer types was due to anatomical, hormonal and genetic differences.

Consideration of gender and sex is necessary and should be included in the clinical management of malignant cases to highlight understanding of biological differences between males and females and to avoid mistakes in diagnosis and management.