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.
Highlights
Hepatocellular carcinoma (HCC) is currently the third most common type of malignancy in men and seventh in women worldwide [1]
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
The age-dependent patterns in the sex difference in the incidence of hepatocellular carcinoma support the hypothesis of a protective role of estrogens
Summary
Hepatocellular carcinoma (HCC) is currently the third most common type of malignancy in men and seventh in women worldwide [1]. Major risk factors for HCC include chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV), alcoholic liver disease, nonalcoholic fatty liver disease, and probably diabetes or obesity [2]. The excess risk of HCC in men is possibly explained by a higher prevalence of established risk factors, e.g., persistent HBV or HCV infection, alcohol use, and smoking in men than in women, and intrinsic exposures with differential distribution between the sexes [2,3,4]. Existing epidemiological evidence remains sparse and conflicting. Based on data from the Surveillance, Epidemiology, and End Results (SEER). Hepatocellular carcinoma possesses a notable sex difference in incidence, and a protective role of estrogens has been hypothesized
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