Global and national trends in the age-specific sex ratio of esophageal cancer and gastric cancer by subtype

Abstract

A male predominance was observed in esophageal and gastric cancers, though present limited data has revealed variations by age. We aim to investigate the global age-specific sex differences in esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia cancer (GCC) and gastric noncardia cancer (GNCC). Data on esophageal and gastric cancers incidence by diagnosis year, sex, histology, subsite and age group were extracted from 171 registries in 54 countries included in the last two volumes (X and XI, 2003-2012) of Cancer Incidence in Five Continents, which contributing to over 80% of the global burdens of these cancers. Age-standardized incidence rates (ASIRs) and male-to-female ASIRs ratios were estimated for esophageal and gastric cancers, by histological subtype and subsite, globally and by country. We consistently observed a male predominance in esophageal and gastric cancers across the world from 2003 to 2012, with male-to-female ASIRs ratios of 6.7:1 for EAC, 3.3:1 for ESCC, 4.0:1 for GCC and 2.1:1 for GNCC. The sex differences were consistent across time periods but varied significantly by age across the life span. Across the four cancer types, the male-to-female incidence rate ratios increased from young ages, approaching a peak at ages 60-64, but sharply declined thereafter. Similar "low-high-low" trends of age-specific sex ratio were observed in other digestive cancers including liver, pancreas, colon and rectum with peak ages ranging from 50 to 65. Age-dependent risk factors warrant further investigation to aid our understanding of the underlying etiologies of esophageal and gastric cancers by histological subtype and subsite.

Keywords: esophageal adenocarcinoma; esophageal squamous cell carcinoma; gastric cardia cancer; gastric noncardia cancer; male-to-female age-standardized incidence rates ratio.

FIGURE 1

Global patterns of age‐specific male‐to‐female incidence rate ratios of esophageal squamous cell carcinoma, esophageal adenocarcinoma, gastric cardia cancer and gastric noncardia cancer (2003‐2012). EAC, esophageal adenocarcinoma; ESCC, esophageal squamous cell carcinoma; GCC, gastric cardia cancer; GNCC, gastric noncardia cancer [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Global patterns of age‐specific male‐to‐female incidence rate ratios of gastrointestinal cancers (2003‐2012) [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Trends of age‐specific male‐to‐female incidence rates ratios of esophageal squamous cell carcinoma and esophageal adenocarcinoma in 39 selected countries (2003‐2012). Countries that reported sex‐specific incidence data of ESCC or EAC with more than ten 5‐year age groups and with data of age groups younger than 45 were included in this analysis. EAC, esophageal adenocarcinoma; ESCC, esophageal squamous cell carcinoma [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Trends of age‐specific male‐to‐female incidence rates ratios of gastric cardia cancer and gastric noncardia cancer in 43 selected countries (2003‐2012). Countries that reported sex‐specific incidence data of GCC or GNCC with more than ten 5‐year age groups and with data of age groups younger than 45 were included in this analysis. GCC, gastric cardia cancer; GNCC, gastric noncardia cancer [Color figure can be viewed at wileyonlinelibrary.com]