Background
In Europe, cancer incidence and mortality have historically been higher among males than among females. However, temporal trends have been heterogeneous across regions and sexes. Whether and to what extent the sex gap has narrowed, and how it may evolve, remains uncertain.
 
Objectives
The objective of this study was to develop scenarios for the future evolution of the male-female gap in all-cancer incidence and mortality across Europe, informed by recent sex-specific trends over the past two decades. Analyses of sex-specific trends in all-cancer mortality have already been completed. Corresponding analyses of all-cancer incidence are ongoing and will be finalised in time for presentation at the conference.
 
Methods
Cancer mortality data for all malignant neoplasms were obtained from the WHO Mortality Database for 30 European countries (1998–2023), while cancer incidence data were sourced from CI5plus and NORDCAN for 15 countries (2001–2017, 2022 for Nordic countries). Corresponding population data were retrieved from the United Nations World Population Prospects. Country-, sex-, and year-specific age-standardised mortality and incidence rates per 100,000 person-years were calculated, and male-to-female ratios were derived. Joinpoint regression analysis was performed on rates to identify significant changes in trends. For each linear trend segment identified by the model, the slope was estimated, together with the weighted average annual percent change (AAPC) over the study period. After evaluating several projection models, rates were projected through 2060 using a linear regression model based on the slope of the most recent trend segment identified by the Joinpoint model.
 
Results
Cancer mortality rates were consistently higher in males than in females throughout the observation period and across all European countries included in the analysis. Over the past two decades, mortality declined in both sexes, more steeply among men, and with marked heterogeneity across regions. Among males, AAPCs ranged from approximately -1.5% in Northern Europe to -2.5% in Western and Eastern Europe, while among females, AAPCs were generally lower, ranging from about -0.5% in Southern and Baltic countries to around -1.5% in Western and Northern Europe. These sex- and region-specific trends translated into a narrowing of the male-female mortality gap across Europe, with, at the end of the observation period, lower ratios observed in Northern Europe (around 1.2), intermediate ratios in Western and Southern Europe (around 1.4), and higher ratios in Eastern and Baltic countries (around 2). Cancer mortality rates among women may converge with those among men in 12 countries by 2040, in 21 countries by 2050, and in up to 25 European countries by 2060.
 
Conclusions/Implications
Across Europe, the male-female gap in cancer mortality has narrowed, driven by steeper declines among males than among females. If current trends persist, this sex differential may reverse in the coming decades, with females bearing a higher cancer mortality burden than males in most European countries. These findings underscore the need to strengthen prevention, early detection, and treatment strategies for cancers disproportionately affecting females, and to integrate sex-specific insights into cancer control policies and resource allocation.