It is a new topic, especially when it comes to oncology. Because if in other sectors the differences between men and women in the incidence, symptoms or response to treatments of some diseases (for example those of the cardiovascular system) collect more and more evidence, when it comes to cancers the way to go is still a lot. “For a long time, gender medicine in oncology remained confined only to the reproductive aspect”, comments for example Rossana BerardiProfessor of Oncology at the Polytechnic University of Marche, Director of the Oncology Clinic of the University Hospital of Marche and member of the AIOM National Board. “Today, however – continues Berardi – we have increasing scientific evidence, including epidemiological evidence, which helps to understand how there are important biological differences based on sex in the response to treatments”. And also in the side effects of oncological therapies, which for women are often more important. “Identifying the pathophysiological bases responsible for biological differences, that is linked to sex, and socio-cultural, that is, related to gender, represents an indispensable step to combine greater therapeutic efficacy with fewer toxic effects”, underlines Alessandra Carèof the Reference Center for gender medicine at the Istituto Superiore di Sanità.
We need a gender oncology
Part of the AIOM (Italian Association of Medical Oncology) conference on the “Days of ethics in oncology” was dedicated to gender medicine, and in particular to its possible applications in the oncology field. With an eye, as well as to research and the clinic, also to the economy: a gaze of gender, he comments Francesco Saverio Mennini, who teaches Health Economics and Political Economy at the University of Rome “Tor Vergata”, can also generate a reduction in costs – because the use of targeted therapies guarantees a better use of resources – and savings, generated by better adherence to therapies that avoid errors in prescriptions, greater safety of treatments and therapeutic appropriateness. “By selecting in advance the patients who can respond to the therapies – says Mennini – unnecessary expenses can be avoided, allocating the saved resources to the treatment of other important pathologies”. Here then is the main evidence in oncology on sex and gender differences.
Cancer, 71% of transgender people do not access screening
by Elisa Manacorda
In colorectal cancer
Colorectal cancer is the second most common cancer among women (after breast cancer) and third for men (after lung and prostate cancer), and is the third leading cause of cancer death in both populations. . The two sexes also differ in the location of the tumor. A recent retrospective study of 186,000 patients (46.1 percent women and 53.9 men) diagnosed in Germany between 2000 and 2016 showed a preferential localization in the right ascending tract in women (45% women and 36.7% men), and a more aggressive form of this neoplasm. Indeed depending on the development site – he explains Erika Martinelli, from the Department of Precision Medicine of the Luigi Vanvitelli University of Campania – the tumor is associated with different molecular and pathological characteristics that determine its aggressiveness. Better survival, including disease-free survival, was observed in women, although men were older at diagnosis and received fewer chemotherapy treatments. It should be considered that the greater distance from the terminal part of the intestine could make screening for occult blood in the faeces less valid, with a greater probability of false negatives.
Immunotherapy in melanoma: do men and women respond differently?
by Tina Simoniello
In bladder cancer
Every year in Italy more than 20,000 men and about 5,000 women get sick with this cancer. Worldwide, this cancer is the fourth most common in men and the seventeenth in women. This means that men have a 3 times higher risk than women of developing this neoplasm. However, today the incidence of this disease is decreasing in men, while in women it is significantly increasing. One of the main causes of this gap reduction is cigarette smoking: smokers have a risk of developing the disease that is almost five times higher than non-smokers. The increase of women smokers – he adds Giuseppe Procopio, oncologist at the National Cancer Institute of Milan – can explain the increase in cases. The first sign of this tumor may be the appearance of blood in the urine. Because women have urinary tract infections more often than men, they are typically given multiple courses of antibiotics before being diagnosed. This delay (85 days on average compared to 73 for humans) can have consequences on prognosis and quality of life. 15 percent of women are over 6 months late, 25 percent over 9 months, with a worse quality of life.
Cancer, five million avoidable deaths without smoking, alcohol and obesity
by Fabio Di Todaro
In head and neck tumors
They are among the cancers with the greatest sex-gender imbalance. The ratio of males to females is 4 to 1. But the incidence is increasing among women. In the two sexes there is a different distribution of tumor sites: for example those of the HPV-related oropharynx are more frequent in men, those of the oral cavity are more frequent in women. Lifestyle habits (smoking and alcohol) also influence distribution, but women have a better prognosis, even if they receive less frequent intensive or radical treatment than men. Moreover, less frequently than men, female patients have a caregiver to rely on, which is instead a fundamental factor that also brings benefits in terms of survival, as he explains. Laura Locati, of the Department of Internal Medicine and Medical Therapy of the University of Pavia, IRCCS ICS Maugeri. Not only that: women also have greater difficulty returning to active life after surgery. If part of the jaw is removed, for example, women feel more mutilated from an aesthetic point of view, more often than men they avoid eating in public, thus giving up an important part of social life, and they also have greater difficulties in rehabilitation of the larynx if this is compromised, with alterations of the voice and consequent great impact on relationships.
Cancer treatment: women have more side effects than men
by Tina Simoniello
In lung cancer
In Italy, as well as in industrialized countries in general, lung neoplasms represent the first cause of death from cancer in the male population and the second in women, after breast cancer. But since the 1950s, the incidence of this cancer in women has increased significantly, as has the death rate, which in recent years among women has risen by 5 percent. The reasons for this growth must certainly be traced to the spread of tobacco consumption in the female population (out of 12 million smokers in Italy, 5.5 million are women). And for the same number of cigarettes, women are more likely than men to develop lung cancer. To contribute to this growth – he says Fabiana Cecere, of the National Cancer Institute Regina Elena in Rome – however, there are also other factors: exposure to passive smoke (for example that of the partner if a smoker), to radon, to asbestos, to atmospheric pollutants such as fine dust, which they promote inflammation in the alveoli even of non-smokers. Several studies have also shown that women tend to be younger at the time of diagnosis, with better survival regardless of the initial stage of the disease, and a more effective response to chemotherapy.