Sex Disparities in Childhood Cancer Diagnoses in India

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In a study reported in The Lancet Oncology, Bhatia et al found that boys were significantly more likely than girls to be diagnosed with childhood cancers in India.

Study Details

The retrospective multicohort study involved individual data from patients aged 0 to 19 years from hospital-based records of three cancer centers in India between January 2005 and December 2019, as well as from two population-based cancer registries: the Delhi registry (from January 2005 to December 2014) and the Madras Metropolitan Tumour Registry (from January 2005 to December 2017).

The primary outcome measures were the male-to-female incidence rate ratio (MF-IRR) in the two population-based cancer registries and the male-to-female ratio (MFR) from the hospital-based data. For population-based cancer registry data, the MF-IRR was estimated by dividing the MFR by the total population at risk. MFR was analyzed for patients seen at the cancer centers, including those undergoing hematopoietic stem cell transplantation (HSCT).

Key Findings

The analysis included data from 11,375 children from population-based cancer registries and 22,893—including 514 who underwent HSCT—from the hospital-based cohort.

The MFR of children at diagnosis was 2.00 (95% confidence interval [CI] = 1.92–2.09) in the Delhi registry and 1.44 (95% CI = 1.32–1.57) in the Madras Metropolitan Tumour Registry. The MF-IRRs for cancer diagnosis were 1.69 (95% CI = 1.61–1.76) in the Delhi registry and 1.37 (95% CI = 1.26–1.49) in the Madras Metropolitan Tumour Registry.

The MFR for children seeking treatment in the hospital-based cohort was 2.06 (95% CI = 2.00–2.12); among those undergoing HSCT, the MFR was 2.81 (95% CI = 2.32–3.43).  

In subgroup analyses, the proportion of boys seeking treatment was higher in northern India than in southern India (P < .0001); in private centers vs in centers providing subsidized treatment (P < .0001); in patients with hematologic vs solid malignancies (P < .0001); in patients residing ≥ 100 km vs < 100 km from the hospital (P < .0001); and in those living in rural vs urban areas (P = .0006).

No significant annual change in the MFR was observed in the overall hospital-based cohort or in any of the individual centers over the study period. A significant decline in the MF-IRR was observed in the Delhi registry from 2005 to 2014 (P = .031) but not in the Madras Metropolitan Tumour Registry.

The investigators concluded, “The sex ratio for childhood cancer in India has a bias towards boys at the level of diagnosis, which is more pronounced in northern India and in situations demanding greater financial commitment. Addressing societal sex bias and enhancing affordable health care for girls should be pursued simultaneously in India.”

Sameer Bakhshi, MD, of the Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, is the corresponding author for The Lancet Oncology article.

Disclosure: The authors reported that there was no external funding for the study. For full disclosures of the study authors, visit

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