Gender differences in survival and the use of primary care prior to diagnosis of three cancers: an analysis of routinely collected UK general practice data.

Yingying Wang,Nick Freemantle,Irwin Nazareth,Kate Hunt,Masaru Katoh

doi:10.1371/journal.pone.0101562

Abstract

ObjectiveTo explore whether there are gender differences in the number of GP recorded cases, the probability of survival and consulting pattern prior to diagnosis amongst patients with three non-sex-specific cancers.DesignCross sectional study.SettingUK primary care.Subjects12,189 patients aged 16 years or over diagnosed with colorectal cancer (CRC), 11,081 patients with lung cancer and 4,352 patients with malignant melanoma, with first record of cancer diagnosis during 1997–2006.Main outcome measuresCancer cases recorded in primary care; probability of survival following diagnosis; and number of GP contacts within the 24 months preceding diagnosis.ResultsFrom 1997–2006, overall rates of GP recorded CRC and lung cancer cases recorded were higher in men than in women, but rates of malignant melanoma were higher in women than in men. Gender differences in survival were small; 49% of men and 53% of women survived at least 5 years following CRC diagnosis; 9% of men and 12% of women with lung cancer, and 77% of men and 86% of women with malignant melanoma. The adjusted male to female relative hazard ratio of death in all patients was 1.20 (95%CI 1.13–1.30), 1.24 (95%CI 1.16–1.33) and 1.73 (95%CI 1.51–2.00) for CRC, lung cancer and malignant melanoma respectively. However, gender differences in the relative risk were much smaller amongst those who died during follow-up. For each cancer, there was little evidence of gender difference in the percentage who consulted and the number of GP contacts made within 24 months prior to diagnosis.ConclusionsThis study found that patterns of consulting prior to cancer diagnosis differed little between two genders, providing no support for the hypothesis that gender differences in survival are explained by gender differences in consultation for more serious illness, and suggests the need for a more critical view of gender and consultation.

Highlights

Women live longer than men in almost all countries [1]
From 1997–2006, overall rates of GP recorded colorectal cancer (CRC) and lung cancer cases recorded were higher in men than in women, but rates of malignant melanoma were higher in women than in men
Gender differences in survival were small; 49% of men and 53% of women survived at least 5 years following CRC diagnosis; 9% of men and 12% of women with lung cancer, and 77% of men and 86% of women with malignant melanoma

Summary

Introduction

Women live longer than men in almost all countries [1]. Both biological and social explanations have been posited for this gender difference [2]. Well documented gender differences in the frequency of contact with primary health care services, in particular in early adult life and middle age, based both on selfreported [6] and routinely collected consultation data [7,8], have led many to suggest that differences in health service use are an important contributor to gender differences in mortality. Such arguments are bolstered by qualitative studies which have documented men’s apparent reluctance to consult [9,10]. We present an analysis of consultations made by cancer patients as recorded in a large general practice database, examining consultation pattern amongst men and women in the 24 months prior to a recorded diagnosis with three non-sex specific cancers, namely colorectal cancer, lung cancer and malignant melanoma

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Discussion

Conclusion