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Sexual Differences in Cancer Survival: Hormones or Stage at Diagnosis?

Albert B. Lowenfels, MD
JAMA. 1990;264(14):1810. doi:10.1001/jama.1990.03450140030021.
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To the Editor.—  Based on Swedish cancer data, Adami et al1 suggest that female sexual hormones provide survival advantage in cancer patients. Their evidence is that female subjects fewer than 20 years past menarche with certain cancers have better survival rates than men of similar age. Although their hypothesis may be correct, it is not easily verified. There is a simpler hypothesis that could be tested.Stage of disease, currently the best predictor of survival, was not included in the analysis. If postpubertal males had more advanced disease at initial presentation than females, the results would be as observed in the current study. Because of close parental supervision of prepubertal children, time from onset of disease to intervention would be expected to be similar in both sexes. However, in the postpubertal period adult supervision diminishes, and teenage girls might respond to symptoms more rapidly than boys. This hypothesis also


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