Current Colorectal Cancer Reports

, Volume 6, Issue 1, pp 4–7

Considering Gender Differences When Planning a Screening Program

Article

Abstract

In light of the huge population at risk for colorectal cancer (CRC) and limited screening resources, shifting the use of screening tests from low-risk to high-risk groups is a valid option. This study reviews the gender of potential screenees as a factor influencing CRC screening yield and overall results. The higher risk of advanced neoplasia, better endoscopy performance, and greater endoscopy screening uptake in men should be taken into consideration when planning an optimized CRC screening program.

Keywords

Colorectal cancer Screening Gender 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Boyle P, Ferlay J: Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005,16:481–488.CrossRefPubMedGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008, 58:71–96.CrossRefPubMedGoogle Scholar
  3. 3.
    Wichman MW, Muller C, Hornung HM, et al.: Gender differences in long-term survival of patients with colorectal cancer. Br J Surg 2001, 88:1092–1098.CrossRefGoogle Scholar
  4. 4.
    McArdle CS, McMillan DC, Hole DJ: Male gender adversely affects survival following surgery for colorectal cancer. Br J Surg 2003, 90:711–715.CrossRefPubMedGoogle Scholar
  5. 5.
    Lieberman DA, Weiss DG, Bond JH, et al.: Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 2000, 343:162–168. (Published erratum appears in N Engl J Med 2000, 343:1204.)Google Scholar
  6. 6.
    Regula J, Rupinski M, Kraszewska E, et al.: Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006, 355:1863–1872.CrossRefPubMedGoogle Scholar
  7. 7.
    • Denis B, Ruetsch M, Strentz P, et al.: Short term outcomes of the first round of a pilot colorectal cancer screening programme with guaiac based faecal occult blood test. Gut 2007, 56:1579–1584. This was the first population-based FOBT study to report significant gender differences in the NNS to detect advanced neoplasia.Google Scholar
  8. 8.
    •• Nguyen SP, Bent S, Chen Y-H, Terdiman JP: Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009, 7:676–681. This recent meta-analysis of screening colonoscopy studies confirms and quantifies gender as a risk factor for advanced neoplasia.Google Scholar
  9. 9.
    Imperiale TF, Wagner DR, Lin CY, et al.: Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000, 343:169–174.CrossRefPubMedGoogle Scholar
  10. 10.
    Schoenfeld P, Cash B, Flood A, et al.: Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005, 352:2061–2068.CrossRefPubMedGoogle Scholar
  11. 11.
    Stewart BT, Keck JO, Duncan AV, et al.: Difficult or incomplete flexible sigmoidoscopy: implications for a screening programme. Aust N Z J Surg 1999, 69:19–21.CrossRefPubMedGoogle Scholar
  12. 12.
    Eloubeidi MA, Wallace MB, Desmond R, et al.: Female gender and other factors predictive of a limited screening flexible sigmoidoscopy examination for colorectal cancer. Am J Gastroenterol 2003, 98:1634–1639.CrossRefPubMedGoogle Scholar
  13. 13.
    Adams C, Cardwell C, Cook C, et al.: Effect of hysterectomy status on polyp detection rates at screening flexible sigmoidoscopy. Gastrointest Endosc 2003, 57:848–853.CrossRefPubMedGoogle Scholar
  14. 14.
    Aslinia F, Uradomo L, Steele A, et al.: Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital. Am J Gastroenterol 2006, 101:721–731.CrossRefPubMedGoogle Scholar
  15. 15.
    Hoff G, Bretthauer M, Huppertz-Hauss G, et al.: The Norwegian Gastronet project: continuous quality improvement of colonoscopy in 14 Norwegian centres. Scand J Gastroenterol 2006, 41:481–487.CrossRefPubMedGoogle Scholar
  16. 16.
    Shah HA, Paszat LF, Saskin R, et al.: Factors associated with incomplete colonoscopy: a population based study. Gastroenterology 2007, 132:2297–2303.CrossRefPubMedGoogle Scholar
  17. 17.
    Saunders BP, Fukumoto M, Halligan S, et al.: Why is colonoscopy more difficult in women? Gastrointest Endosc 1996, 43:124–126.CrossRefPubMedGoogle Scholar
  18. 18.
    Thiis-Evensen E, Hoff GS, Sauar J, et al.: Patient tolerance of colonoscopy without sedation during screening examination for colorectal polyps. Gastrointest Endosc 2000, 52:606–610.CrossRefPubMedGoogle Scholar
  19. 19.
    Kim WH, Cho YJ, Park JY, et al.: Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc 2000, 52:600–605.CrossRefPubMedGoogle Scholar
  20. 20.
    Ko CW, Riffle S, Shapiro JA, et al.: Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc 2007, 65:648–656.CrossRefPubMedGoogle Scholar
  21. 21.
    • Othman MO, Bradley AG, Choudhary A, et al.: Variable stiffness colonoscope versus regular adult colonoscope: meta-analysis of randomized controlled trials. Endoscopy 2009, 41:17–24. This was the first meta-analysis of randomized controlled trials to compare colonoscopy performance using variable-stiffness and regular adult colonoscopes.Google Scholar
  22. 22.
    Hoff G, Bretthauer M, Dahler S, et al.: Improvement in caecal intubation rate and pain reduction by using 3-dimensional magnetic imaging for unsedated colonoscopy: a randomized trial of patients referred for colonoscopy. Scand J Gastroenterol 2007, 42:885–889.CrossRefPubMedGoogle Scholar
  23. 23.
    Evans R, Brotherstone H, Miles A, Wardle J: Gender differences in early detection of cancer. J Mens Health Gend 2005, 2:209–217.CrossRefGoogle Scholar
  24. 24.
    Courtenay WH, McCreary DR, Merighi JR: Gender and ethnic differences in health beliefs and behaviours. J Health Psychol 2002, 7:219–231.CrossRefGoogle Scholar
  25. 25.
    Kronborg O, Fenger C, Olsen J, et al.: Randomised study of screening for colorectal cancer with fecal occult blood test. Lancet 1996, 348:1472–1477.CrossRefGoogle Scholar
  26. 26.
    Hardcastle JD, Chamberlain JO, Robinson MHE, et al.: Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996, 348:1472–1477.CrossRefPubMedGoogle Scholar
  27. 27.
    Tazi MA, Faivre J, Dassonville F, et al.: Participation in faecal occult blood screening for colorectal cancer in a well defined French population: results of five screening rounds from 1988 to 1996. J Med Screen 1997, 4:147–151.PubMedGoogle Scholar
  28. 28.
    Meissner HI, Breen N, Klabunde CN, Vernon SW: Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev 2006, 15:389–394.CrossRefPubMedGoogle Scholar
  29. 29.
    Atkin WS, Hart A, Edwards R, et al.: Uptake, yield of neoplasia, and adverse effects of flexible sigmoidoscopy screening. Gut 1998, 42:560–565.PubMedCrossRefGoogle Scholar
  30. 30.
    Segnan N, Senore C, Andreoni B, et al.: Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 2007, 132:2304–2312.CrossRefPubMedGoogle Scholar
  31. 31.
    Hol L, Van Leerdam ME, Van Ballegooijen M, et al.: Screening for colorectal cancer; randomized trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 2009, 59:62–68.Google Scholar
  32. 32.
    Frew E, Wolstenholme J, Whynes D: Mass population screening for colorectal cancer: factors influencing subjects’ choice of screening test. J Health Serv Res Policy 2001, 6:85–91.CrossRefPubMedGoogle Scholar
  33. 33.
    Farraye FA, Wong M, Hurwitz S, et al.: Barriers to endoscopic colorectal cancer screening: are women different from men? Am J Gastroenterol 2004, 99:341–349.CrossRefPubMedGoogle Scholar
  34. 34.
    Harewood GC, Wiersema MJ, Melton LJ 3rd: A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol 2002, 97:3186–3194.CrossRefPubMedGoogle Scholar
  35. 35.
    Wardle J, Williamson S, McCaffery K, et al.: Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults. Health Psychol 2003, 22:99–105.CrossRefPubMedGoogle Scholar
  36. 36.
    •• Brenner H, Hoffmeister M, Stegmaier C, et al.: Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut 2007, 56:1585–1589. This study estimated the risk of progression of advanced adenomas to colorectal cancer by combining data from the largest published cohort of screening colonoscopy participants and national cancer registry data.Google Scholar
  37. 37.
    Brenner H, Hoffmeister M, Arndt V, et al.: Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer 2007, 96:828–831.CrossRefPubMedGoogle Scholar
  38. 38.
    • Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG, et al.: Individualizing colonoscopy screening by sex and race. Gastrointest Endosc 2009, 70:96–108. This study is a microsimulation model–based cost-effectiveness analysis of individualizing colonoscopy screening by sex and race.Google Scholar
  39. 39.
    Ness RM, Holmes AM, Klein R, Dittus R: Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages. Am J Gastroenterol 2000, 95:1800–1811.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of GastroenterologyInstitute of Oncology and Medical Center for Postgraduate EducationWarsawPoland

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