A review of sex-related differences in colorectal cancer incidence, screening uptake, routes to diagnosis, cancer stage and survival in the UK

Abstract

BackgroundColorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. There is still a dearth of understanding on where sex differences exist along the pathway from presentation to survival. The aim of this review is to identify where actions are needed to improve outcomes for both sexes, and to narrow the gap for CRC.MethodsA cross-sectional review of national data was undertaken to identify sex differences in incidence, screening uptake, route to diagnosis, cancer stage at diagnosis and survival, and their influence in the sex differences in mortality.ResultsOverall incidence is higher in men, with an earlier age distribution, however, important sex differences exist in anatomical site. There were relatively small differences in screening uptake, route to diagnosis, cancer staging at diagnosis and survival. Screening uptake is higher in women under 69 years. Women are more likely to present as emergency cases, with more men diagnosed through screening and two-week-wait. No sex differences are seen in diagnosis for more advanced disease. Overall, age-standardised 5-year survival is similar between the sexes.ConclusionsAs there are minimal sex differences in the data from routes to diagnosis to survival, the higher mortality of colorectal cancer in men appears to be a result of exogenous and/or endogenous factors pre-diagnosis that lead to higher incidence rates. There are however, sex and gender differences that suggest more targeted interventions may facilitate prevention and earlier diagnosis in both men and women.

Demographic trends in the incidence of young-onset colorectal cancer: a population-based study

“…This study provided no evidence of an association between SES and the rate of increase in incidence of either proximal or distal tumours, in contrast to previous studies where higher incidence rates were observed in more deprived groups. Although factors associated with an increased risk of colorectal cancer, such as obesity, low‐fibre diet and reduced physical activity, are known to be associated with lower SES, changes in obesity prevalence trends are actually similar between socioeconomic groups; this may partly explain the lack of association between SES and colorectal cancer incidence rate increases in the present study. Furthermore, obesity is one of many risk factors associated with the development of colorectal cancer, and is itself caused by several complex societal, genetic and environmental interactions.…”

“…Although men are well recognized to have a higher incidence of colonic and rectal cancer in older age groups, there is little difference in the incidence rates between men and women aged less than 40 years. UK data have shown that men have a higher proportion of rectal tumours, but that women have a higher proportion of right‐sided tumours. However, data on anatomical subsite have not been linked to age‐specific incidence trends in the UK population.…”

Gender medicine and oncology: report and consensus of an ESMO workshop

“…Furthermore, differences in fat distribution might contribute to the persistent inflammation associated with GERD and the development of Barrett's oesophagus [82]. Other examples of sex differences in the biology of GI cancers are as follows: in colorectal cancer, a breakdown by anatomical site shows that the proportion of cases in the rectum and sigmoid are higher in men (31.5% and 23.1%, respectively), as compared to 23.1% and 20.4% [83]. In contrast, the proportion of cases in the caecum and ascending colon are higher in women (17.2 versus 9.8%) [83].…”

A retrospective study for Colorectal Cancer in Vlore, Albania-suggestions for further implications

“…Colorectal cancer is one of the most commonly occurring cancers in men and women worldwide as well as one of the most common causes of death from cancer [1]. Due to exogenous and/or endogenous factors, the mortality of colorectal cancer is higher in men than women [2]. Colorectal cancer mainly affects older adults, but the incidence is rising among the young population [3].…”