Age-specific sex difference in the incidence of hepatocellular carcinoma in the United States

Abstract

BackgroundHepatocellular carcinoma possesses a notable sex difference in incidence, and a protective role of estrogens has been hypothesized.MethodsUsing data from 13 cancer registries in the Surveillance, Epidemiology, and End Results Program, we describe the age-specific sex difference in the incidence of hepatocellular carcinoma in the United States during 1992-2013. We used a curve fitting by non-linear regression to quantitatively characterize the age-specific incidence rate of hepatocellular carcinoma by sex.ResultsA total of 44,287 incident cases of hepatocellular carcinoma (33,196 males and 11,091 females) were included, with an overall male-to-female ratio in age-standardized rate of 3.55. The sex ratio was below 2 at ages <25 years, increased with age from ages 25-29 years until peaking at 5.40 at ages 50-54 years, and declined thereafter. We also observed additional peaks in the age-specific sex ratio curves at ages 25-34 years across racial/ethnic groups. Modelling of age-specific incidence rates indicated a 15-year delayed increase with age in females compared with males in Asian and Pacific Islanders, and an 11-year delay in Hispanic whites.ConclusionsThe age-dependent patterns in the sex difference in the incidence of hepatocellular carcinoma support the hypothesis of a protective role of estrogens. The underlying reasons for the sex difference in hepatocellular carcinoma remain to be further explored in analytic epidemiological studies.

Risk factors for hepatocellular carcinoma by age, sex, and liver disorder status: A prospective cohort study in Korea

“…[16][17][18] Men are known to be at a higher risk of HCC compared with women. 8,19 However, to the best of our knowledge, the finding that the multivariable adjusted relative risk of male sex decreased with age in middle-aged and elderly individuals is novel. The protective role of estrogen has been suggested as an explanation for sexual dimorphism.…”

Linear age‐course effects on the associations between body mass index, triglycerides, and female breast and male liver cancer risk: An internal replication study of 800,000 individuals

“…The causes for our findings on liver cancer are unclear and may have several explanations. The male to female incidence ratio of liver cancer ranges from 2:1 to 4:1 across populations, which has been hypothesized to be caused by a higher prevalence of strong risk factors among men including hepatitis B and C virus infection, alcohol intake, smoking, and also potentially by sex hormones . Moreover, obesity has been related to an increased liver cancer risk among men in particular, which may suggest an influence by sex‐specific effect modifiers .…”

Sex difference in the incidence of cardia and non-cardia gastric cancer in the United States, 1992-2014

“…Analyzing the age-speci c patterns of the sex difference in incidence may provide etiological clues on risk factors with age-dependent associations with gastric cancer risk. Particularly, if estrogens protect against the development of gastric cancer in women as hypothesized, the protective effect may be stronger before the menopausal ages than at postmenopausal ages, and thus, the male-to-female incidence ratio may decline accordingly after menopausal ages [13][14][15][16]. Our ndings indicate a declined male-to-female ratio in the incidence of cardia cancer but not in that of non-cardia cancer.…”