Gender disparities in colorectal cancer screening.

Abstract

1544 Background: Prior research suggests that recurrence and survival from colorectal cancer are worse in men than in women, but the causes for this disparity are as yet unclear. Our aims were to 1) assess for gender differences in colorectal cancer screening (CRCS) as a potential cause for the male-female disparities in colorectal cancer outcomes and 2) examine the impact of income, education and insurance status on gender differences in CRCS. Methods: Screening-eligible patients were identified from the US California Health Interview Survey. Up-to-date CRCS was defined as a fecal occult blood test within the past 2 years, a flexible sigmoidoscopy within 5 years, or a colonoscopy within 10 years. Logistic regression models were constructed to evaluate the relationship between gender and CRCS while controlling for other clinical factors, such as age, race, smoking history, marital status and health services use. Stratified analyses based on ‘health care access’ as measured by self-reported income (low vs. high), education (< highschool vs. > highschool), and health insurance status (insured vs. uninsured) were performed to determine if gender differences were modified by these parameters. Results: In total, 11,260 men and 17,705 women were identified: mean age was 65 and 66 years, respectively, and 63% were White in both genders. In the entire cohort, only about two-thirds of men and women reported undergoing up-to-date CRCS. In multivariate analyses, advanced age, White race, urban residence, non-smokers, married and those who visited their physicians frequently were more likely to receive CRCS (all p<0.001). When compared to men, women had decreased odds of CRCS (OR 0.88, 95% CI 0.82-0.94, p<0.001), after adjusting for potential confounders. Stratified analyses indicated that gender disparities in CRCS persisted even among the insured, educated, and high income earners. Conclusions: Women are less likely to undergo CRCS when compared to men. Gender-specific interventions that raise awareness about preventive care may be more effective in optimizing CRCS than conventional strategies aimed at improving health care access. The observation that colorectal cancer outcomes are worse in men than in women is unlikely to be explained by gender disparities in CRCS.