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

Alan White,Lucy Ironmonger,Robert J C Steele,Nick Ormiston-Smith,Carina Crawford,Amanda Seims

doi:10.1186/s12885-018-4786-7

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.

Highlights

Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females
Incidence of Colorectal cancer In the UK, 2012–2014 incidence rates in adults aged 45 and over were significantly higher for males than females and this gap was widest at ages 70–74 where the male:female incidence ratio of age-specific rates was 1.7:1 [11] (Fig. 1)
A breakdown of CRC incidence by anatomical site (Table 1) shows that the proportions of CRC cases in the rectum and sigmoid colon are higher in males (31.5% and 23.1%, respectively) than females (23.1% and 20.4%, respectively)

Summary

Introduction

Colorectal cancer (CRC) is an illness strongly influenced by sex and gender, with mortality rates in males significantly higher than females. CRC is a disease that has both biological sex differences and socio-cultural gender components [3,4,5,6,7,8,9,10]. CRC mortality rates are higher in men (ASRs of 33.9 per 100,000 males c.f. 21.8 per 100,000 females) [11]. Mortality rates are significantly higher for males than for females in all age groups from 45 to 49 and. White et al BMC Cancer (2018) 18:906 over, and the gap is widest at the ages of 70–74, when the male:female age-specific mortality rate ratio is around 1.7:1 [11]. There is a global trend for men to have both higher incidence (746,298 vs 614,304 [20.6 vs14.3 ASR]) and mortality (373,639 vs 320,294 [10 vs 6.9 ASR]) for CRC [12]

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