We know that a woman’s heart works differently than a man’s heart. But what about cancer? The Integrated Cancer Center of the Netherlands (IKNL) investigated these differences for the first time. The ten most eye-catching ones in a row. ‘The fear when men hear that they have cancer is so great.’
Ellen van GaalenNovember 30, 2023, 3:00 am
1. Men are more likely to be diagnosed with cancer
If you look at the types of cancer that both men and women can get, men get sick more often. In part, this is due to the lifestyles of men decades ago. For example, they smoked more, they more often had professions in which they worked with asbestos, for example, and they drank more alcohol. As a result, men are more likely to develop lung cancer, mesothelioma (asbestos cancer) and esophageal cancer.
2. Increasing rates of esophageal cancer in women
Esophageal cancer mainly occurs in men. “That has to do with their lifestyle, more belly fat, which pushes stomach acid up,” explains oncological surgeon Grard Nieuwenhuijzen of the Catharina Hospital in Eindhoven. But in recent years, women have been on the rise, at least for one of the variants: squamous cell carcinoma. “That’s because they started smoking and drinking more.” The same applies to lung cancer; this is now increasing because women started smoking more in the 1970s.
The research
With these results, IKNL hopes that more attention will be paid to gender differences in cancer care. The cancer institute sees the results as starting points for more research, for example into the question of why women sometimes receive different treatment than men. They argue that the research results should be stated separately for men and women. Ultimately, new insights can lead to ‘more targeted treatments’ for men and women, but with the same results. In this way, cancer care for patients can be improved.
3. Bladder cancer is discovered later in women
Bladder cancer is more common in men, but is often discovered later in women. “Patients usually get blood in their urine. This also applies to bladder infections. Because bladder infections are more common in women, they are more likely to be diagnosed with bladder infections first,” explains urologist Evert Koldewijn of the Catharina Hospital in Eindhoven. Only if a course of antibiotics does not work are they referred to a urologist and a diagnosis of bladder cancer can still follow.
That is a difficult problem, Koldewijn acknowledges. Not every drop of blood is bladder cancer, so when do you refer a patient to the hospital? “There will be a study to make it easier to detect malignant cells in urine. Maybe that can help to reduce the differences between men and women.”
4. Men sometimes sound the alarm later
With melanoma, on the other hand, men visit the doctor later. “They more often have spots on the torso, possibly because in some professions they work with their upper body bare,” says John Haanen, internist-oncologist at the Antoni van Leeuwenhoek in Amsterdam. “It may be that they don’t sound the alarm until it’s too late. In women, melanomas are more likely to occur on the legs or arms and are often more visible.”
Moreover, women may also be a little more careful and more likely to go to the doctor if they have a strange spot. Nieuwenhuijzen also sees this with thyroid cancer, a disease that also causes men to visit the doctor later. “I think men ignore it more when they see a lump in the neck. They only consult a GP at a later stage, with more metastases.”
5. Women are more likely to survive
In general, the survival rate for women with cancer is higher than for men. This applies, for example, to melanoma and thyroid cancer. Only with bladder cancer is the chance of survival lower because the disease is detected late. The IKNL takes into account that the extent to which the treatment is successful can also contribute to a difference in survival rates between men and women. More research needs to be done on this.
6. Older women are less likely to opt for drastic treatment
Women are less likely to receive treatment aimed at healing, such as surgery. Older women in particular more often receive only supportive care to reduce complaints and have a good quality of life. “I see in the consultation room that women more often accept the situation as it is when they receive a diagnosis later in life. Men are much more in a fighting position,” Nieuwenhuijzen notes. For esophageal cancer, for example, they can opt for major surgery or just chemotherapy and radiation. “I notice that more women choose the latter and go for quality of life. They think about it differently.”
Although it is certainly worth doing more research into this. Is it really the choice of these women themselves? Or do doctors unconsciously choose a different type of treatment for these patients? “It’s about the health outcomes: they must be equal. And a difference can help with that,” summarizes Toine Lagro-Janssen, emeritus professor of Women’s Studies in Medical Sciences at Radboud University Medical Center.
7. Women’s bodies respond differently to medications
Because not all treatments have the same effect on women as on men. Women can react strongly to medication, for example chemotherapy or immunotherapy. This has everything to do with how the woman’s body processes medicines, says Lagro-Janssen, and the lack of research into this. “Women get side effects one and a half times as often as men. But most drug studies include more men. This already starts with animal experiments on male rats.”
Medicines disappear less quickly from the female body. The enzymes in the liver that break down medication are simply adjusted differently. As a result, the same dose of chemo can have a greater impact on women. “They have more exposure to that drug, they suffer more from side effects, but it may also be that the cancer cells are attacked harder,” says Haanen.
An oncology nurse working on chemotherapy with a patient. Image anp
So yes, this doctor acknowledges, perhaps the dose of certain medications should be different for men than for women. “We now mainly look at the weight of the patients, but do not correct for gender. I would need more substantiation for that, because you don’t want to undertreat someone. But it could be that a woman has fewer side effects if she receives a slightly lower dose.”
8. Women’s immune systems protect better (and that has consequences)
Women have a ‘sharper defense’. This was also clear during the corona pandemic: more men than women became seriously ill. Women are simply better protected against viruses and bacteria. Haanen: “Men really get sicker from the flu.” Yet women do not necessarily get less cancer because their immune system recognizes bad cells better. Scientists do not yet know exactly why this happens. And with immunotherapy, this strong defense can be counterproductive: more women develop thyroid complaints as a side effect.
9. Hormones also cause cancer
It is known that hormones can also influence the disease. As a result, for example, many young women develop hormonal breast cancer or ovarian cancer. “If you know more about the pathogenesis of the disease, you may also be able to use other forms of therapy. That is why it is important to know more about this. Doctors should always ask themselves: does it matter whether I have a man or a woman sitting in front of me?” says Professor Lagro-Janssen. Because the male hormone can also influence the development of cancer. This is the case with prostate cancer. Haanen: “But we don’t know, for example, whether this hormonal influence decreases at a certain age, after menopause. We should investigate that too.”
10. Impact is greater on men
The IKNL research shows that the impact of the disease appears to be greater on men. That was an eye-opener for oncological surgeon Nieuwenhuijzen. “I was impressed by how much of an impact it has on men. Men express this less and ask for help less. I should pay more attention to that. During my consultation hours this afternoon, I will look more at how men respond to what I say and offer them help more actively.”
In the treatment of breast cancer, a disease that mainly affects women, the guidance is ‘incredibly good’, Nieuwenhuijzen knows. But with colon cancer, which is more common in men, this is much less well regulated. “Maybe this is also because fewer women get the disease. Men simply ask for support less often. They want to fix it more on their own. But when I see how men react when they hear that they have cancer… That fear is so great. We need to pay more attention to that.”
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2023-11-30 02:00:16
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