Gastric cancer: how differences between men and women may influence diagnosis and treatment

Gastric cancer remains a major global health burden. Although its incidence has declined over recent decades, largely owing to improvements in living conditions and better management of risk factors such as Helicobacter pylori infection, it continues to rank as the fifth most common cancer worldwide and one of the leading causes of cancer-related mortality.

The review, led by researchers from Hospital Clínic Barcelona, the University of Barcelona, IDIBAPS and CIBEREHD offers a new perspective on the disease. The findings suggest that men and women differ not only in how often they develop gastric cancer, but also in the biological characteristics of their tumours, their risk factors and the way the disease progresses The study has been published in the Journal of Clinical Medicine. 

More than half a million patients analysed

The review analysed data from 38 international studies involving more than 500,000 patients with gastric cancer. Its aim was to bring together available evidence on how biological sex and gender-related factors may influence incidence, tumour characteristics, risk factors, treatment, and survival.

“The differences between men and women go beyond epidemiology. They may also influence clinical presentation, tumour characteristics, treatment response and disease progression. Incorporating a sex and gender perspective is not optional; it is essential to delivering high-quality care and providing more accurate, personalised and equitable treatment,” explains Dr Sabela Carballal, a researcher in the Gastroenterology Department at Hospital Clínic Barcelona and co-lead author of the study.

The findings highlight the need to systematically incorporate a sex and gender perspective into both research and clinical practice to support the development of more personalised medicine.

Why is gastric cancer more common in men? 

One of the most consistent findings of the review is that gastric cancer occurs around twice as often in men as it does in women.

The researchers suggest that this difference likely reflects a combination of biological and environmental influences. Oestrogen may exert a protective effect before menopause, while lifestyle-related risk factors, such as smoking and alcohol consumption, are much more common among men across the studies included in the review.

Sex differences in gastric cancer 

The review also shows that these differences are not limited to incidence. Men and women are more likely to develop different types of tumours.

Men are more likely to develop the intestinal subtype of gastric cancer, which is commonly associated with environmental risk factors such as Helicobacter pylori infection, diet and smoking. By contrast, women—particularly younger women—are more likely to develop diffuse, poorly differentiated tumours, which generally have a more aggressive clinical course.

Survival is not the same for everyone 

The picture is more complex when it comes to survival. Many studies suggest that women have better overall survival than men, particularly when gastric cancer is diagnosed at an early stage.

However, this advantage is not consistent across all patients. Several studies found that younger women with diffuse tumours may have poorer outcomes, underlining the importance of age, tumour histology and stage at diagnosis in determining prognosis.

Why should sex and gender be taken into account?

The authors note that much of the existing evidence is based on observational studies and that women have historically been under-represented in gastric cancer research.

They argue that future research and clinical trials should systematically incorporate sex- and gender-based analyses. A better understanding of these differences can help design more effective prevention strategies, improve early diagnosis, and tailor treatments to each patient’s individual characteristics.

INFORMATION DOCUMENTED BY:

Dr Sabela Carballal, Gastroenterology Department at Clínic Barcelona