Registre général des cancers de Poitou-Charentes, Pôle Biologie, Pharmacie et Santé Publique, CHU de Poitiers, Poitiers, France.
Université de Poitiers, Bâtiment D1, 6 rue de la Milétrie, 86073, Poitiers, France.
BMC Cancer. 2021 Jun 24;21(1):726. doi: 10.1186/s12885-021-08261-1.
To analyze trends in cancer incidence and mortality (France, 1990-2018), with a focus on men-women disparities.
Incidence data stemmed from cancer registries (FRANCIM) and mortality data from national statistics (CépiDc). Incidence and mortality rates were modelled using bidimensional penalized splines of age and year (at diagnosis and at death, respectively). Trends in age-standardized rates were summarized by the average annual percent changes (AAPC) for all-cancers combined, 19 solid tumors, and 8 subsites. Sex gaps were indicated using male-to-female rate ratios (relative difference) and male-to-female rate differences (absolute difference) in 1990 and 2018, for incidence and mortality, respectively.
For all-cancers, the sex gap narrowed over 1990-2018 in incidence (1.6 to 1.2) and mortality (2.3 to 1.7). The largest decreases of the male-to-female incidence rate ratio were for cancers of the lung (9.5 to 2.2), lip - oral cavity - pharynx (10.9 to 3.1), esophagus (12.6 to 4.5) and larynx (17.1 to 7.1). Mixed trends emerged in lung and oesophageal cancers, probably explained by differing risk factors for the two main histological subtypes. Sex incidence gaps narrowed due to increasing trends in men and women for skin melanoma (0.7 to 1, due to initially higher rates in women), cancers of the liver (7.4 to 4.4) and pancreas (2.0 to 1.4). Sex incidence gaps narrowed for colon-rectum (1.7 to 1.4), urinary bladder (6.9 to 6.1) and stomach (2.7 to 2.4) driven by decreasing trends among men. Other cancers showed similar increasing incidence trends in both sexes leading to stable sex gaps: thyroid gland (0.3 to 0.3), kidney (2.2 to 2.4) and central nervous system (1.4 to 1.5).
In France in 2018, while men still had higher risks of developing or dying from most cancers, the sex gap was narrowing. Efforts should focus on avoiding risk factors (e.g., smoking) and developing etiological studies to understand currently unexplained increasing trends.
分析法国 1990-2018 年癌症发病率和死亡率的趋势，重点关注男女差异。
发病率数据来自癌症登记处（FRANCIM），死亡率数据来自国家统计数据（CépiDc）。使用年龄和年份的二维惩罚样条（分别为诊断时和死亡时）对发病率和死亡率进行建模。通过所有癌症、19 种实体瘤和 8 个亚部位的年龄标准化率的平均年百分比变化（AAPC）来总结趋势。1990 年和 2018 年，发病率和死亡率的性别差距分别用男性与女性的发病率比（相对差异）和发病率差异（绝对差异）来表示。
在所有癌症中，1990-2018 年发病率的性别差距缩小（从 1.6 缩小至 1.2），死亡率的性别差距缩小（从 2.3 缩小至 1.7）。男性与女性发病率比值下降最大的癌症是肺癌（从 9.5 缩小至 2.2）、唇-口腔-咽（从 10.9 缩小至 3.1）、食管（从 12.6 缩小至 4.5）和喉（从 17.1 缩小至 7.1）。肺癌和食管癌的趋势混杂，可能是由于两种主要组织学亚型的风险因素不同所致。由于男性和女性皮肤黑色素瘤（从 0.7 增加至 1，因为女性最初的发病率更高）、肝癌（从 7.4 增加至 4.4）和胰腺癌（从 2.0 增加至 1.4）的发病率呈上升趋势，因此性别发病率差距缩小。由于男性的发病率呈下降趋势，结直肠癌（从 1.7 缩小至 1.4）、膀胱癌（从 6.9 缩小至 6.1）和胃癌（从 2.7 缩小至 2.4）的性别发病率差距缩小。其他癌症在两性中的发病率呈相似的上升趋势，导致性别差距保持稳定：甲状腺（从 0.3 增加至 0.3）、肾脏（从 2.2 增加至 2.4）和中枢神经系统（从 1.4 增加至 1.5）。
2018 年在法国，尽管男性患大多数癌症或死于大多数癌症的风险仍然较高，但性别差距正在缩小。应努力避免风险因素（如吸烟），并开展病因学研究，以了解目前无法解释的上升趋势。
