In 20 Different Cancers, Men More Likely to Be Diagnosed at a Later Stage

Men had a higher likelihood than women for late-stage diagnosis of 20 different types of cancer, data from a national registry network showed.

The analysis of 30 nonreproductive organ cancers showed men had higher odds ratios for regional or distant metastasis at diagnosis in two-thirds of the cancer types. Men had a significantly higher risk of regional spread at diagnosis for 16 cancers and distant metastasis for 17. The largest male/female disparity was for tongue, thyroid, and salivary gland cancers, as later-stage diagnosis occurred twice as often. Only for bladder cancer did men have significantly lower odds of later-stage diagnosis (for both regional and distant spread).

Cancers where men had a higher odds for both regional and distant metastasis at diagnosis included several cancers of the head and neck, melanoma, and gastric, lung, thyroid, and kidney cancers, among others.

The findings add to men’s long-recognized higher risk of dying of cancer and could provide insight into reasons for the disparity, reported Beth Maclin, PhD, MPH, of the National Cancer Institute (NCI) in Bethesda, Maryland, and colleagues in Cancer Epidemiology, Biomarkers & Prevention.

“The findings of this study underscore pronounced and site-specific sex differences in cancer stage at diagnosis, suggesting the need for targeted strategies for early detection and intervention,” the authors concluded. “Additional studies are warranted to investigate the underlying causes of these stage differences in order to inform future interventions focused on reducing diagnostic delays, particularly for males.”

The results added to multiple observational studies that have “consistently shown that men are less likely than women to participate in preventive healthcare, including cancer screening. This has been consistent with my own clinical experience,” said Jose Barreau, MD, of PreOncology, a Florida-based oncology practice focusing on prevention and early detection.

“The disparity is likely driven by a combination of biological, behavioral, and healthcare utilization factors,” Barreau told MedPage Today. “Men are generally less likely to have regular interactions with the healthcare system, are less likely to establish ongoing primary care relationships, and often delay seeking medical evaluation. Traditional gender norms may also contribute, with many men underestimating risk or postponing preventive care until symptoms arise. Practical barriers such as work schedules and access to care also play a role.”

“Improving participation will require making prevention more personalized, easier to access, and more clearly connected to an individual’s actual risk rather than relying solely on age-based recommendations,” he added.

The results “are not surprising” and are consistent with studies “published many years ago,” showing sex-based disparities in stage at cancer diagnosis, said Jingqin Luo, PhD, of Washington University in St. Louis.

“This is a very comprehensive and updated analysis using the most recent data,” Luo, who is an expert for the American Association for Cancer Research, told MedPage Today. “This study dives more deeply into site-specific analysis and stratifies by race and income and other factors, so it kind of addresses how social determinants of health influence the diagnosis stage.”

The study represented a continuation of previous work showing that men are more likely to die of cancer than women, the authors noted in their introduction. Using data from the NCI Surveillance, Epidemiology, and End Results registry program, they performed a pan-cancer analysis to examine sex differences in cancer stage at diagnosis.

The analysis encompassed 30 nonreproductive solid organ cancers diagnosed from 2015 to 2022, excluding 2020. Investigators performed multiple logistic regression calculations to assess associations between sex and stage of disease at diagnosis (localized vs regional and localized vs distant) for each cancer site.

The analysis included 2,401,772 patients, and men accounted for 56.9% of the study population. About 45% of cancers were localized at diagnosis. The most commonly diagnosed cancers in men were lung (20.3%), colon (15.7%), and bladder (11.1%), as compared with lung (26%), colon (18.2%), and thyroid (9.8%) in women.

Diagnosis at regional versus localized stage occurred significantly more often in men for 16 of the 30 cancers. The largest adjusted ORs (aORs) were for cancers of the:

• Tongue: aOR 2.51, 95% CI 2.40-2.64
• Salivary gland: aOR 1.93, 95% CI 1.78-2.09
• Oropharynx: aOR 1.80, 95% CI 1.51-2.14
• Thyroid: aOR 1.74, 95% CI 1.69-1.78
• Stomach: aOR 1.67, 95% CI 1.61-1.74
• Lung and bronchus: aOR 1.25, 95% CI 1.23-1.27
• Kidney and renal pelvis: aOR 1.22, 95% CI 1.19-1.25

Men had significantly higher odds for distant metastasis at diagnosis for 17 of the 30 cancers, including:

• Tongue: aOR 2.34, 95% CI 2.16-2.53
• Thyroid: aOR 2.28, 95% CI 2.14-2.43
• Salivary gland: aOR 1.97, 95% CI 1.77-2.20
• Stomach: aOR 1.56, 95% CI 1.51-1.62
• Melanoma: aOR 1.50, 95% CI 1.43-1.56
• Bones and joints: aOR 1.46, 95% CI 1.28-1.68
• Lung and bronchus: aOR 1.35, 95% CI 1.33-1.36
• Kidney and renal pelvis: aOR 1.30, 95% CI 1.26-1.34

Men were significantly less likely to have regional-stage diagnoses for larynx and bladder cancers and significantly less likely to have distant metastasis at diagnosis for bladder, anal, and liver cancers.

As for how to address the diagnostic disparities, a personalized approach to preventive care, particularly cancer screening, may encourage better attendance and adherence, said Barreau.

“Rather than simply recommending guideline-based screening, I focus on helping patients understand their individual cancer risk based on genetics, family history, lifestyle, medical history, and other clinical factors,” he said. “When people understand why a recommendation applies specifically to them, they are much more likely to follow through.”

Viewing cancer screening as an ongoing process, rather than a single test, might also help with adherence.

“The science [underlying cancer testing] is evolving rapidly, and no single screening modality is sufficient for every individual or every cancer,” said Barreau. “Our goal is to help primary care physicians navigate that complexity by matching the right screening strategy to the right patient at the right time, with continuous reassessment as both the patient’s biology and the evidence evolve.”