Female Reproductive Cancers and the Sex Gap in Survival.

The sex gap in truncated cross-sectional average length of life (TCAL) varied substantially across the 20 countries studied.

• The sex gap in TCALs ranged from 8.31 (95% CI, 8.28-8.34) years in Hungary to 4.22 (95% CI, 4.20-4.25) years in the Netherlands.
• The analysis encompassed 264.4 million deaths from all causes (119.1 million female [45.1%]; 145.2 million male [54.9%]).
• 11.5 million deaths from female reproductive cancers were included in the analysis.
• Population-level mortality data spanned from 1955 to 2020 across 20 countries with complete records.

Females had a survival advantage over males for most major causes of death, except for neoplasms at reproductive ages.

• Across all countries, females had a survival advantage for major causes of death, except for neoplasms at reproductive ages.
• Females aged between 35 and 60 years experienced a consistent cross-cohort excess in cancer mortality compared with males.
• The excess cancer mortality in females at reproductive ages was mainly due to breast cancer and, to a lesser extent, gynecological cancers.
• This pattern was described as consistent across birth cohorts and over time.

Eliminating female reproductive cancers would increase female survival and expand the sex gap in TCALs by an estimated mean of 0.77 years.

• The estimated mean expansion of the sex gap in TCALs from eliminating female reproductive cancers was 0.77 (95% CI, 0.75-0.78) years.
• The country-level range was from 0.96 (95% CI, 0.92-1.00) years in Ireland to 0.51 (95% CI, 0.50-0.52) years in Japan.
• Eliminating female reproductive cancers would both increase the survival of females and widen the existing sex gap.
• The TCAL metric incorporates historical mortality information for all birth cohorts alive at a given time.

The study used TCAL decomposition by birth cohort, age, and calendar year to quantify sex differences in survival.

• The primary outcome was the truncated cross-sectional average length of life (TCAL), which incorporates historical mortality information for all birth cohorts alive at a given time.
• For each country, the sex gap in survival was calculated, decomposed, and presented graphically by birth cohort, age, and calendar year.
• Data sources included the Human Mortality Database and World Health Organization Mortality Databases.
• The 20 countries included Australia, Austria, Belgium, Canada, Denmark, Finland, France, Hungary, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, the UK, and the US.
• Data were analyzed from January 2023 to September 2025.

The female disadvantage in cancer mortality at reproductive ages was a consistent pattern observed across birth cohorts and over calendar time.

• The excess cancer mortality among females aged 35 to 60 years was described as a 'consistent cross-cohort excess.'
• The pattern was observed across all 20 countries studied.
• Breast cancer was identified as the main driver of this female cancer mortality excess, with gynecological cancers contributing to a lesser extent.
• The findings were stated to 'underscore the ongoing need for action on the prevention, early detection, and treatment of early-onset female reproductive cancers.'