Women,Men,and Cancer Survivorship: A Commentary on Current Data and Possible Underlying Issues

Abstract

Tonorezos et al.’s recent analysis of U.S. cancer survivorship prevalence provides insightful commentary on the dramatic increase of those surviving the disease over the last 50 years. This growth is reflective of improvements in cancer detection, treatment, and the effects of an aging population. While survival rates have seen a significant increase, more focus is needed on the long term and postsurvivorship health care. What Tonorezos et al.’s piece also indicates is that survivorship trends reveal disparities based on several variables, such as age, sex, and cancer type. Women tend to be diagnosed earlier and have higher survival rates when compared to men, arguably due to more frequent screenings vis-a-vis a sequela of increased utilization of care. Men have higher cancer incidence rates among the aging population, accompanied by lower survival rates, frequently linked to late diagnosis and less utilization of preventive care. Addressing sex-specific disparities is pivotal to developing future treatment plans among cancer survivors. Health care providers must adjust to the multifaceted demands of the population. Public health movements should focus on increasing awareness and promotion of early detection in the male population, taking note of the successful initiatives seen in women’s health. It is imperative that these disparities and long-term needs are assimilated into the comprehensive conversation about cancer care to improve outcomes for all survivors.

Commentary Overview

The following commentary is written in direct response to Tonorezos et al.’s (2024) presentation of cancer survivorship prevalence in the United States. It is our collective opinion that the piece provides quality data on the state of cancer survivorship, which can assist in health care planning, service providing, public health initiatives, and clinical intervention word. The piece also leaves some issues unaddressed, particularly sex-specific differences in cancer survivorship.

We first provide a general summary of cancer survivorship and demographic-specific distributions. We then direct our attention to sex-specificity regarding cancer survivorship and provide future directions to the field to help progress the narrative of helping achieve health equity.

A Summary of Cancer Survivorship

The number of cancer survivors in the United States has seen a dramatic rise over the past five decades. Currently nearing 20 million individuals, the survivor population is expected to continue growing well into the mid-21st century (National Cancer Institute, 2024). This is a trend that is both a testament to the advancements in cancer care (e.g., the development of more potent and effective chemo- and radiation therapies) and a reflection of broader sociodemographic changes (e.g., increasing life expectancy) and policy/advocacy initiatives (e.g., earlier and more frequent screening procedures leading to an increase in early-stage diagnoses and an aging population).

Cancer survivorship expansion, generally, is driven by multiple factors, including an aging population, as well as significant improvements in early detection, innovative treatment protocols, and supportive care measures that have extended both life expectancy and quality of life for cancer patients (Miller et al., 2022). The success of these efforts, however, has created new challenges for the health care system, which must now address the long-term survivorship needs of a diverse and increasingly older patient population.

Survivorship prevalence varies significantly across cancer types, age groups, sexes/genders, as well as racial/ethnic demographic groups (Dong et al., 2020). Older adults make up a substantial portion of the survivor population due to both their higher incidence of cancer and their increased likelihood of living with the aftereffects of treatment (Mohamed et al., 2024; Parry et al., 2011). Racial and ethnic minority groups, however, have disparate access to survivorship care protocols (Tarver et al., 2024) and access to consistent high-quality care, which may lead to earlier mortality rates compared to their counterparts.

One other issue that presents itself with a burgeoning cancer survivorship population hinges on primary care. While primary care providers undeniably provide a crucial role in the care of cancer patients and survivors, they may not be as familiar with the intricacies and complexities of long-term care associated with survivorship (Grunfeld & Earle, 2010; Mukherjee et al., 2023). For example, cancer survivors not only overcame the immediate threat of cancer but often face a host of ongoing medical issues that arise because of their disease and its treatment. Late effects—such as chronic fatigue, cognitive decline, and psychological stress—persist long after treatment ends, presenting complex challenges for survivors and their health care providers (Stein et al., 2008; Reeve et al., 2023). These effects can diminish quality of life and exacerbate pre-existing conditions, further complicating the management of survivorship care, especially for older populations.

Fragmentation in care delivery is a common consequence of this gap, which can lead to suboptimal health outcomes. Moreover, the complexity of managing survivors’ multifaceted needs requires a more coordinated approach, combining oncology expertise with primary care and social work services to address both the physical and psychological consequences of cancer treatment. This multidisciplinary approach is needed to provide these patients with optimal care. The increasing number of survivors, particularly in older age groups, makes this an urgent concern, as the health care system must evolve to support both the acute and long-term needs of this growing population.

Cancer Prevalence and Sex-Specific Distributions

Issue 1

Tonorezos et al. notes, expectedly, that the proportion of cancer survivors is higher among 60+ year olds. They further discuss how cancer prevalence increases with age for both men and women. A noteworthy distinction in these data, however, is that across cancer sites, the overall proportion of survivors is higher for women across most age groups. The exception is the 70-to-79 age group where men significantly outnumber women. The 0-to-9 and 10-to-19 age groups have marginal differences, all but indicating equity at least in these two categories.

As Davis et al. (2011) indicated that women are screened more often and earlier in their lives than men and Kirtane et al. (2023) showcased that women are more likely to have their first cancer-related course treatment at a select National Cancer Institute-designated cancer center than men, we, therefore, raise some tangential questions as a product of Tonorezos et al.’s data. Specifically, what are the incidence rates for men and women? What are the stages for each cancer site between men and women? What kind of access to services and knowledge of cancer is prevalent among both men and women? Although Tonorezos et al.’s piece may not have necessarily focused on these issues, they are critically relevant because they can affect the number of individuals diagnosed with the disease at specific age strata, if cases are discovered at earlier stages, and how many opportunities men and women have to learn about cancer risk and discovery, let alone being screened for cancer.

This is not a new point, however. Many have been calling for increased screening among younger men for early detection and awareness. In a study on male college students, for example, Wanzer et al. (2013) reported that those who were educated in testicular cancer awareness had a significant increase in the likelihood of performing self-exams. By educating men in the early years of when testicular cancer can occur (15 years+), the reported cases of testicular cancer will increase, but will be detected earlier in diagnoses which would allow for better survival rates. Saab et al. (2016), further, analyzed the effectiveness of the methods of spreading testicular cancer awareness through 11 different studies. These included videos, stickers, TV shows, university campaigns, and self-efficacy messages. The reported findings found that men of all ages benefited from at least one form of testicular cancer education, increasing the probability of these men performing self-exams and identifying symptoms.

Would the discrepancies concerning sex and cancer survivorship level off if men went to the doctor regularly, and in turn, were screened more often and earlier in their lives? If so, an urgent public health crisis presents itself to aid men in undergoing preventive screenings more often and having better access to more excellent care.

Issue 2

Tonorezos et al. illustrated that women survivors grew in total proportion of the U.S. population while men stagnated in each age strata from 2022 to a project 2040 date. Such increases can come from true cancer proliferation among women between comparative time points or more women getting screened more often. In 2022, for example, approximately 19.7% of females aged 75 to 84 years were cancer survivors. This proportion is expected to rise to 22.5% by 2040. This trend is mirrored in almost every other age category. In contrast, the proportion of male cancer survivors is projected to remain relatively similar across age groups over the same period. One very notable exception is among those aged 85 years and older where both the 2022 statistics and 2040 projection indicate that nearly half of men were and will continue to be cancer survivors compared to ~36% (2022) and ~42% (2040 projection) of women.

As Vincent and Velkoff’s (2010) piece indicated that women outnumber men in older ages and projected this into the year 2050, knowing what the raw sex-specific numbers of the U.S. population for men and women at those ages would be helpful to fully interpret the data. Although nearly 50% of 85+-year-old men are cancer survivors, for example, the number of women alive beyond 85 years of age are that much higher than men, therefore lowering their proportion total. Further explanations for why women have a consistently higher projected proportion than men could include that women could be undergoing screenings more often and getting diagnosed earlier in life, arguably translating to higher survival rates (see Rovito et al., 2022). Public health efforts are needed, therefore, to address sex-related discrepancies in cancer diagnosis and general mortality. Specifically, interventions are needed to educate male populations in all age strata about cancer prevention and screening, including healthy lifestyle choices, health care access, and navigating conversations between them and their physicians.

Suggested Next Steps

Sex-specific differences in cancer manifestation, incidence, and survivorship underscore the need for tailored, gender-responsive approaches to cancer care. Variations in cancer prevalence between men and women, compounded by differences in screening practices, age-related risks, and health care utilization, demand a nuanced understanding of how cancer impacts each sex differently. Men tend to have lower survival rates, likely due in part to less frequent screenings and later-stage diagnoses (Haupt et al., 2021). Conversely, women, while having higher survival rates, face longer-term survivorship needs, placing distinct demands on the health care system.

The need to integrate sex-specific perspectives into the broader conversation about cancer survivorship is urgent. Men’s underutilization of cancer screenings compared to women likely contributes to their higher mortality rates. The challenge is not only ensuring earlier detection in men but also acknowledging the complex, long-term care needs of women, who, by surviving longer, require more comprehensive survivorship care. Tonorezos et al. emphasizes that primary care providers often lack access to necessary cancer treatment histories, creating gaps in follow-up care that must be addressed, especially as the survivor population continues to grow and age. Closing this gap is critical to ensuring survivors receive appropriate care for late effects of treatment and ongoing health management.

Future efforts should focus on promoting gender-equitable screening practices, including encouraging self-examinations and routine screenings for men. Public health campaigns must raise awareness about the importance of regular screenings for men, similarly to the successful initiatives targeting women’s health such as breast cancer examination. Further research is required to determine whether cancers in men are developing later or if care is being accessed too late in the disease process. This may be an advantageous opportunity for the United States Preventives Services Task Force (USPSTF) to shepherd efforts of health equity by calling for public comment on, and possibly even revising, existing screening recommendations. Special attention should be made on how screening recommendations may need to vary depending on risk levels between sociodemographic groups.

The data on cancer survivorship presents a call to action for a health care system that can meet the sex-specific needs of survivors. Addressing these disparities requires not just changes in screening practices but also improvements in survivorship care models that account for the unique health trajectories of both men and women. With the growing survivor population, it is imperative that these considerations be integrated into the broader discourse on cancer care to foster better outcomes for all.