Women More Likely to Survive Melanoma Than Men: Study

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TUESDAY, May 1 (HealthDay News) -- When it comes to surviving the skin cancer known as melanoma, nature appears to have dealt women a better hand than men, new research suggests.

By almost every measure, an analysis of four European studies found that women can expect a 30 percent better outcome than men following an early stage melanoma diagnosis. That gap, researchers say, may be rooted in basic differences in gender biology.

"The 30 percent advantage applies to survival," said study author Dr. Arjen Joosse, from the department of public health at Erasmus University Medical Center in Rotterdam, the Netherlands. "It also applies to having a metastasis [spread]: women have a 30 percent lower chance to experience a metastasis to the lymph nodes and to other organs."

Joosse and colleagues from Belgium, Switzerland, Germany and France published their findings in the April 30 online edition of the Journal of Clinical Oncology.

In an editorial accompanying the study, Dr. Vernon Sondak, chair of the department of cutaneous oncology at the Moffitt Cancer Center in Tampa, Fla., noted that just over 70,000 Americans were diagnosed with invasive melanoma in 2011, and about 43 percent of those were women. But, among the roughly 8,800 melanoma-related deaths that year, only 35 percent were female patients.

Joosse noted that the fact that women tend to fare better than men following a melanoma diagnosis is a well-established observation based on prior research, some of which was conducted by the current study team. However, the reasons behind the prognosis gap have remained elusive.

And the new research found an association between gender and melanoma survival, not a cause-and-effect.

To explore the question, Joosse and his team analyzed data concerning nearly 2,700 melanoma patients that was gleaned from four different melanoma treatment trials conducted in Europe.

All of the male and female melanoma patients had been diagnosed with either stage 1 (early) or stage 2 (localized) cancer. During and following treatment, all the patients were tracked for disease remission, relapse, spread and death.

The result: male melanoma patients were found to have worse disease characteristics at diagnosis and worse disease progression.

On the latter measure, female patients were found to have a "highly consistent and independent advantage" over men in terms of overall survival, both before and after menopause.

The sole exception was seen in cases of head and neck melanomas, where the gender differences disappeared. But the team cautioned that even this exception could ultimately be dismissed as misleading, due to key study peculiarities.

It is not that the initial tumor starts out worse in men than women, the authors stressed. Rather it is something gender-related that causes the cancer to unfold in a more deadly way in men.

In theory, estrogen level differences could play a role, although the team noted that the evidence so far suggests the hormone does not have much effect on melanoma.

Other possibilities include gender differences with respect to vitamin D metabolism, immune system function, male testosterone levels and what is known as "oxidative stress" in the body.

"However, our data could not support or disprove any of these hypotheses," Joosse acknowledged.

Sondak said that while the gender gap is probably real, it is likely a function of both biology and environment.

"I believe that the message here is that if you're a man, think like a woman," said Sondak. "And that's because most of us feel that a big part of this has to do with the fact that women are a little more likely to be paying attention to their skin and to notice something on their skin, and most importantly, to do something about it right away. And with melanoma, early detection is key," he stressed.

"So, I think in large part this is a behavioral issue, not a genetic issue," Sondak added. "However, that's not the whole issue. It is also the case that what we now call melanoma, one disease, may actually be many different diseases caused by many different things. And with that there may be genetic differences, all else being equal, in how men and women get these different diseases in the first place. This study didn't look at that. But that's another important aspect to consider."

More information

For more on melanoma, visit the U.S. National Cancer Institute.

SOURCES: Arjen Joosse, M.D., department of public health, Erasmus University Medical Center, Rotterdam, the Netherlands; Vernon Sondak, M.D., surgeon and chair, department of cutaneous oncology, Moffitt Cancer Center, Tampa; April 30, 2012, Journal of Clinical Oncology, online

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HPV Infection Lasts Longer in Young Black Women: Study

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SUNDAY, April 1 (HealthDay News) -- Human papillomavirus infection tends to lasts longer in college-aged black women than whites, possibly setting them up for a higher risk of cervical cancer, according to a new study.

The researchers also found that black women are 70 percent more likely to have an abnormal Pap test -- the screening for cervical cancer -- than their white counterparts. Human papillomavirus, or HPV, which is a sexually transmitted infection, can cause genital warts and is responsible for many cases of cervical cancer.

"African American women are more likely to have persistent high-risk HPV infection," said study author Kim Creek, vice-chair and professor of pharmaceutical and biomedical sciences at South Carolina College of Pharmacy, in Charleston.

Most HPV infections are transient. "If you are infected, your body recognizes it as a viral infection and usually clears the virus within one or two years," he said. "It is those women who have difficulty clearing it that are at higher risk of cervical disease and cervical cancer."

Exactly why black women have more difficulty clearing the virus is not known. "We think that it likely has something to do with the immune system," he said.

Lifestyle factors and genetic differences may also play a role. "We will try to understand why this occurs because if we could understand the reason for the difference, it would be easier to make public health recommendations about what to do about it," Creek added.

For the study, researchers assessed HPV infection and persistence in college-age women enrolled at the University of South Carolina. The study began in 2004, and the women were followed throughout their college years. HPV status was evaluated every six months in Pap test samples from 326 white women and 113 black women.

The rate of new high-risk HPV infection was similar between the two groups of women, the researchers found, but at any visit, black women were 1.5 times more likely to test positive for high-risk HPV infection. Also, 56 percent of black women were still infected two years after they were first diagnosed, compared with 24 percent of white women.

The findings are slated for presentation Sunday at the annual meeting of the American Association for Cancer Research, in Chicago.

Creek said that black women are 40 percent more likely to develop cervical cancer and two times more likely to die from the disease than European or American white women. This discrepancy is often attributed to lack of access to medical care, but the authors said their findings suggest a biological basis lies behind the varying rates.

Regular screening with the Pap test is the best way to prevent cervical cancer, Creek said. A sample of cells is scraped from a woman's cervix and examined under a microscope. If any abnormal or precancerous cells are detected, measures can be taken to prevent them from developing into cancer.

HPV vaccinations offer protection from the four types of HPV that cause most cervical cancers. These shots are currently recommended for 11- and 12-year-old girls and for females aged 13 to 26 who did not get any or all of the HPV shots when they were younger. The vaccines can be given to girls beginning at 9 years of age.

"African American women may benefit even more from the HPV shots," Creek said.

Dr. Diana Contreras, director of gynecologic oncology at Long Island Jewish Medical Center in New Hyde Park, N.Y., said it is way too early to draw any conclusions about screening and treatment of HPV in black women from this study.

"We are beginning to understand that HPV may behave differently in different ethnic groups," she said. "This study is very provocative, but the jury is still out on screening and treatment, and we have to be careful about drawing too many conclusions."

Data and conclusions of research presented at medical meetings should be considered preliminary until published in a peer-reviewed medical journal.

More information

Learn more about HPV infection at the U.S. Centers for Disease Control and Prevention.

SOURCES: Kim E. Creek, Ph.D., vice-chair and professor, department of pharmaceutical and biomedical sciences, South Carolina College of Pharmacy, Charleston, S.C.; Diana Contreras, M.D., division director, gynecologic oncology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; presentation, American Association for Cancer Research, April 1, 2012, Chicago

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More U.S. Men Die From Cancer Than Women: Study

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TUESDAY, July 12 (HealthDay News) -- Men in the United States are much more likely than women to die of cancer, a new report from the U.S. National Cancer Institute found.

Gender differences in cancer incidence -- more men than women develop cancer in the first place -- rather than differences in cancer survival appeared to drive the findings, the researchers said.

"If we can identify modifiable causes of sex difference in cancer incidence and mortality then preventative actions could reduce the cancer burden in both men and women," said lead researcher Michael B. Cook, a National Cancer Institute epidemiologist.

Cook said that for many cancers, male and female incidence rates, and by extension death rates, have changed disproportionately over time.

This is likely because of differences in "carcinogenic exposures, metabolism and susceptibility," he said. Increased rates of smoking among men, and differences in infections, hormones and contact with toxic metals may all come into play, he said.

In terms of survival, however, the gender gap was minimal, the researchers found.

The study is published in the August issue of Cancer Epidemiology, Biomarkers & Prevention.

To look for gender differences in cancer deaths and survival rates, Cook's team used information from the NCI's Surveillance, Epidemiology and End Results database, which includes information on survival and deaths for 36 different cancers.

Lip cancer, for example, killed 5.51 men for every 1 woman. Larynx cancer claimed the lives of 5.37 men for every 1 woman; throat cancer, 4.47 men for each woman; and urinary bladder cancer, 3.36 men per 1 woman.

Examining cancers with the highest death rates overall, the researchers again found higher mortality among men than women. For example, lung and bronchus cancer killed 2.31 men for every 1 woman. Liver cancer killed 2.23 men for every woman; colon and rectum cancer took 1.42 males' lives for every woman; pancreatic cancer, 1.37 men for each woman; and leukemia, 1.75 men for every woman.

The research team found that gender was not a major factor in five-year survival when age, year of diagnosis and tumor stage were taken into account.

"But, for certain cancers we did observe slight sex differences in survival," Cook said, adding it is difficult to assign any root cause to that observation.

"This is not really a novel finding," said Rebecca Siegel, an epidemiologist at the American Cancer Society, commenting on the study. "We know that men have a higher risk of developing and dying from cancer for a variety of reasons, and some reasons which we don't fully understand," she added.

"The fact they didn't find large differences in survival is comforting," she said.

The death rates reflect different smoking and drinking patterns, Siegel pointed out. Also, cancers related to work exposures are more common among men, she noted.

Because smoking among women peaked in the 1970s and 1980s, Siegel said she expects to see the gender difference in cancer deaths start to narrow.

Men may get diagnosed later than women because they tend to see their doctors less often, and this could affect mortality rates, Siegel also suggested.

Future studies should explore the factors responsible for the disparity, the study authors said.

More information

For more information on cancer, visit the American Cancer Society.

SOURCES: Michael B. Cook, Ph.D., investigator, division of cancer epidemiology and genetics, U.S. National Cancer Institute; Rebecca Siegel, M.P.H., epidemiologist, American Cancer Society, Atlanta; August 2011, Cancer Epidemiology, Biomarkers & Prevention

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