Sex Differences in Cancer Incidence, Mortality, and Survival: Methodological Perspectives

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Background

Population-based cancer registries across the world represent an important source of information on cancer incidence; these are used for many purposes, including a region-wise comparison of trends for different types of cancers and for generating hypotheses. Among the available statistics for studying cancer trends, the most valuable data is of ‘incidence rate’ that comes from recording every case of cancer in a defined geography in a specified time. But there is a downside in relying on published incidence rates from cancer registries. Namely, the published rates are not only determined by the real underlying cancer incidence rates, but also on such regional phenomena as access to diagnostic services/practices in the medical communities, quality and completeness of reporting of cancer diagnoses to the local cancer registries, quality of the cancer registry itself, and data management systems. These methodological aspects can vary from country to country and can even vary within countries.

The methodological shortcomings above can be mitigated, albeit not eliminated if we examine sex ratios in cancer incidence rather than the incidence rates themselves. It can be conjectured that the sex ratio in cancer incidence is a much truer representation of the true sex ratio than the reported incidence rate is of the true incidence rate. This conjecture holds if the degree of error induced by these methodological limitations is similar for both sexes. While this assumption may not be perfectly valid in some societies where females may have less access to diagnostic services, there is a belief in academia that the completeness of registration would be equal for male and female cases in some cancer registries. By relying on the premise that the majority of registries follow international rules of registration, and if we assume equivalent diagnostic and registration criteria/quality between sexes within and between countries then the sex ratio in cancer incidence is a parameter that is relatively unconfounded between countries. Therefore, the analysis of the variability of sex ratios can be useful for generating hypotheses. For comparison of mortality rates, the impediment is that these rates are poor reflections of incidence for to discuss a worldwide landscape of well-informed opinions, perspectives, and original articles that evaluates the methodological milieu such as males relative to females or vice versa thereby termed ‘sex-ratios’ (or even sex-differences) in cancer burden such as incidence, mortality, prevalence, and survival. We also welcome manuscripts discussing methodological issues to analyze cancer trends with problematic inferences and their suggested solutions in low and high-resource countries. These can include not only the historical context of cancer registration over decades but also the utility of cancer registries in making cancer-specific comparisons across the globe. Analysis of sex ratios can have important practical implications for the planning and evaluation of cancer control activities across the globe.

The objective of this Research Topic is to bring together researchers from the fields of cancer epidemiology, surveillance, and prevention to discuss a worldwide landscape of well-informed opinions, perspectives, and original articles that evaluates the methodological milieu such as males relative to females or vice versa thereby termed ‘sex-ratios’ (or even sex-differences) in cancer burden such as incidence, mortality, prevalence, and survival. We also welcome manuscripts discussing methodological issues to analyze cancer trends with problematic inferences and their suggested solutions in low and high-resource countries. These can include not only the historical context of cancer registration over decades but also the utility of cancer registries in making cancer-specific comparisons across the globe. Analysis of sex ratios can have important practical implications for the planning and evaluation of cancer control activities across the globe.

Please note: manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) will not be accepted in any of the sections of Frontiers in Oncology.

Keywords: sex ratio, mortality, Sex differences in cancer incidence, sex differences, disparities

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