September 30, 2026, 6:20 pm | Read time: 5 minutes

Influence of Modifiable Factors Varies Greatly

The lifestyle and health factors examined played different roles in China and the United Kingdom. In China, about 84 percent of the difference in cancer rates between men and women (183 out of 216 additional cancer cases per 100,000 person-years) could be statistically linked to these factors. In the United Kingdom, however, it was only about 26 percent (52 out of 200 cases). This shows that the extent to which such factors are associated with the different cancer rates of men and women can vary significantly from population to population and depending on the societal context.

How the Study Was Conducted

The research team led by Zhuo-Ying Li aimed to determine the extent to which modifiable factors might contribute to men being more frequently diagnosed with cancer than women. Other possible explanations include biological differences, such as genetic traits, sex hormones, or different immune responses. The results were published in the journal “JAMA Oncology.”¹

For their investigation, the researchers analyzed data from a total of 589,766 adults from Shanghai and the UK Biobank. At the start of the study, participants were between 40 and 74 years old and had not been diagnosed with cancer. Over several years, data was collected on who developed cancer.

The researchers examined 34 cancer endpoints that are not gender-specific. Breast cancer and tumors of the reproductive organs were excluded, for example.

Eleven lifestyle and health factors were investigated. These included smoking, heavy alcohol consumption, physical inactivity, diet, and obesity, as well as diabetes, chronic liver diseases, and gallstones. China and the United Kingdom were suitable for comparison because some of these factors affect men and women differently in these countries. In China, behaviors such as smoking (69.6 percent of men vs. 2.8 percent of women) and heavy alcohol consumption (26.6 percent vs. 0.9 percent) almost exclusively affect men, while in the United Kingdom, these habits are more evenly distributed between the genders (smoking: 50.7 percent vs. 39.7 percent).

Smoking Plays the Largest Role in One Country

During the follow-up period, a total of 70,300 cancer cases were recorded. The incidence rate for men was higher than for women in both study populations: In China, it was 1.66 times higher, and in the United Kingdom, it was 1.49 times higher.

The factors that were particularly strongly associated with this difference varied significantly between the two populations. In China, smoking stood out: It was statistically linked to about 52 percent of the difference between men and women. Heavy alcohol consumption accounted for about 15 percent, chronic liver diseases about 10 percent, and low fruit intake also about 10 percent.

In the United Kingdom, the individual contributions were significantly smaller. The largest share was obesity, at about eight percent. This was followed by smoking at about six percent and diabetes at just under four percent.

The researchers verified the stability of their results with several additional calculations, including a ten-year observation period. They arrived at comparable results.

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Strengths and Weaknesses of the Study

The study provides important insights into the role modifiable risk factors might play in the different cancer rates of men and women by comparing two different populations.

However, there are some limitations in the interpretation. Lifestyle and health status were only recorded at the beginning of the study and were partly based on self-reports. Changes over time could not be considered. Additionally, potential influencing factors such as air pollution, occupational stress, and certain infections were missing.

Differences in cancer screening and the composition of the populations studied could also have influenced the results. There are also other methodological aspects: Participants were between 40 and 74 years old at the start, so the findings cannot be generalized to younger adults under 40 or very elderly individuals. In China, women and men were surveyed in slightly different time periods (1997 to 2000 and 2002 to 2006), which could have led to distortions during a phase of rapid lifestyle changes. The British study group also includes a disproportionately healthy, socioeconomically better-off population. Therefore, the results cannot be easily applied to other countries, age groups, or populations.

Also of interest: Marital status apparently influences cancer risk

Previous Studies Point to Biological Causes

The results from the United Kingdom align with an earlier U.S. study. A team from the National Cancer Institute led by Sarah Jackson analyzed data from nearly 300,000 adults aged 50 to 71.² Men were more frequently diagnosed with most non-gender-specific cancers than women, with esophageal adenocarcinoma occurring almost 11 times more often. Lifestyle, body weight, and pre-existing conditions explained only part of this difference: about half for lung cancer and only about 11 percent for esophageal cancer. The authors see this as an indication of biological causes.

What these causes might look like is shown by an analysis of more than 4,100 tumors from 21 cancer types.³ Women have two X chromosomes, one of which is largely inactivated. However, some genes on this second X, which normally protect against cancer, remain active. If the only copy of such a gene in men is lost due to a mutation, the protection is completely absent. In women, the second copy compensates. Indeed, six of these X genes were more frequently mutated in men, while no such difference was found for other genes.