A Pan-Cancer Analysis of Age and Sex Differences in Cancer Incidence and Survival in the United States, 2001-2020

Our plain-English summary of A Pan-Cancer Analysis of Age and Sex Differences in Cancer Incidence and Survival in the United States, 2001-2020, by R.C. Selvaraj, G. Cioffi, K.A. Waite, et al (Cancers, 2025).

The study

• Authors: R.C. Selvaraj, G. Cioffi, K.A. Waite, S.S. Jackson, J.S. Barnholtz-Sloan
• Journal: Cancers
• Published: 2025;17(3)
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: In cancer, age and sex are often studied individually, but the impact of the intersection of these factors on cancer incidence and survival remains unclear. Using population-level data, we provide an up-to-date analysis of the impact of sex and age on cancer incidence and survival.

Methods: Using data from the United States Cancer Statistics public use research database and the Centers for Disease Control and Prevention's National Program of Cancer Registries Survival database, we assessed sex and age differences in the incidence and survival of malignant cancers diagnosed from 2001 to 2020.

Results: Males experienced higher cancer incidence than females in all sites and age groups, excluding 20-29- and 30-39-year-olds. The highest Male-to-female (M:F) age-adjusted incidence rates (IRR) were observed in mesothelioma within ages 80+ (IRR: 5.48; 95% CI: 5.25-5.71; p < 0.001), and lowest in endocrine cancer within ages 20-29 years (M:F IRR: 0.20; 95% CI: 0.20-0.21; p < 0.001). Among all sites and age groups, excluding 0-9 years, males experienced worse survival than females, particularly within ages 20-29 years (Hazard Ratio (HR): 2.19; 95% CI: 2.15-2.23; p < 0.001). Highest M:F HRs were observed in endocrine system cancers within ages 20-29 (HR: 3.52; 95% CI: 3.15-3.94; p < 0.001), and lowest among lymphomas within ages 0-9 (HR: 0.74; 95% CI: 0.63-0.87; p < 0.001).

Conclusions: Significant age and sex differences in cancer incidence and survival were observed across the US from 2001 to 2020. Males had a higher cancer incidence compared to females, with notable exceptions for younger age groups among certain types, suggesting age may be a critical component in further understanding the biology of sex differences in cancer.

In plain English

This study compared US cancer rates and survival between males and females by 10-year age group, using registry data. It covered 15,769,051 people diagnosed in 2001–2020 with non-sex-specific cancers; survival analyses covered 14,462,616. Males had higher incidence for all included cancers combined, except at ages 20–29 and 30–39, where the female excess was driven heavily by endocrine system cancers (male-to-female incidence rate ratios 0.71, 95% CI 0.70–0.71, and 0.81, 95% CI 0.80–0.81). The highest ratios were for mesothelioma at older ages: 3.79 (95% CI 3.63–3.97) at 60–69, 4.66 (95% CI 4.48–4.84) at 70–79, and 5.48 (95% CI 5.25–5.71) at 80 and over. For all cancers combined, males had worse survival than females in every age group except 0–9. In mesothelioma, males generally had worse survival, particularly at ages 20–29 (hazard ratio 3.00; 95% CI 1.89–4.75), but not at ages 0–9 and 10–19. Asbestos exposure was not measured; the authors noted other studies attributing higher male mesothelioma rates to asbestos. The analysis did not include treatment history or socioeconomic status, nor adjust for race, region, stage or treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-based analysis of US cancer registry data: male-to-female incidence rate ratios and age-stratified Cox survival models
• Who was studied: 15,769,051 people (8,823,617 male, 6,945,434 female) in the United States diagnosed from 2001 to 2020 with a first-primary, non-sex-specific malignant cancer; survival analyses on 14,462,616 people (8,090,970 males, 6,371,646 females)
• Exposure: The factors compared were sex (male versus female) and age group at diagnosis. Asbestos and other exposures were not measured. The discussion cites other studies attributing higher mesothelioma rates in males to asbestos exposure.
• Main results:
  • Mesothelioma had the highest male-to-female incidence rate ratios, in older age groups: ages 60–69 IRR 3.79 (95% CI 3.63–3.97), ages 70–79 IRR 4.66 (95% CI 4.48–4.84), ages 80+ IRR 5.48 (95% CI 5.25–5.71), all p < 0.001
  • Among people diagnosed with mesothelioma, males generally had worse survival than females (p < 0.001), particularly at ages 20–29 (M:F HR 3.00; 95% CI 1.89–4.75; p < 0.001)
  • The worse mesothelioma survival in males was not seen at ages 0–9 and 10–19
  • For all primary sites pooled, females aged 20–29 and 30–39 had higher incidence than males of the same age (M:F IRR 0.71, 95% CI 0.70–0.71; M:F IRR 0.81, 95% CI 0.80–0.81; both p < 0.001)
  • Endocrine system cancers made up 33% of all tumors in females aged 20–29 and 30–39, versus 10% in males aged 20–29 and 9% in males aged 30–39
  • For all sites combined, males had worse survival than females in every age group except ages 0–9 (p < 0.001). The difference was most evident at ages 20–29 (M:F HR 2.19; 95% CI 2.15–2.23).
  • Endocrine cancer at ages 20–29 had the lowest male-to-female incidence ratio (M:F IRR 0.20; 95% CI 0.20–0.21) but the highest male-to-female hazard ratio for survival (M:F HR 3.52; 95% CI 3.15–3.94)
• The authors' conclusion: The authors concluded that there were significant age and sex differences in US cancer incidence from 2001 to 2020. Males generally had higher incidence, with exceptions in specific age groups and cancer types. Males generally had worse survival.
• Limitations the authors state:
  • Only variables available in cancer registry datasets could be analyzed. Factors such as treatment history, pathogenesis, molecular biomarkers and socioeconomic status were not included in the analysis.
  • Possible variation by race, region, stage and treatment was not adjusted for or considered, as this was outside the scope of the work

Topics

Medical terms in this study, explained in our Lexicon: Incidence, Mesothelioma, Hazard Ratio.

Related studies

• Contemporary Trends in Malignant Peritoneal Mesothelioma: Incidence and Survival in the United States — L. Calthorpe, F. Romero-Hernandez, et al. (2022)
• Trends in Pleural Mesothelioma Incidence and Survival in Metropolitan and Nonmetropolitan Areas in the United States — A.J. Didier, C. Lennox, et al. (2025)
• Time trend of mesothelioma incidence in the United States and projection of future cases: an update based on SEER data for 1973 through 2005 — B. Price, A. Ware (2009)
• Mesothelioma incidence in 50 states and the District of Columbia, United States, 2003-2008 — S.J. Henley, T.C. Larson, et al. (2013)
• Recent trends in mesothelioma incidence in the United States — R. Spirtas, G.W. Beebe, et al. (1986)
• Mesothelioma in the United States. Incidence in the 1970's — M.W. Hinds (1978)

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