Predictors of CRC Stage at Diagnosis among Male and Female Adults Participating in a Prospective Cohort Study: Findings from Alberta's Tomorrow Project.

Monica Ghebrial,Qinggang Wang,Karen A. Kopciuk,Paula J. Robson,Lorraine Shack,John J. Spinelli,Michelle L. Aktary

doi:10.3390/curroncol28060414

Abstract

Colorectal cancer (CRC) is a leading cause of morbidity and mortality in Canada. CRC screening and other factors associated with early-stage disease can improve CRC treatment efficacy and survival. This study examined factors associated with CRC stage at diagnosis among male and female adults using data from a large prospective cohort study in Alberta, Canada. Baseline data were obtained from healthy adults aged 35–69 years participating in Alberta’s Tomorrow Project. Factors associated with CRC stage at diagnosis were evaluated using Partial Proportional Odds models. Analyses were stratified to examine sex-specific associations. A total of 267 participants (128 males and 139 females) developed CRC over the study period. Among participants, 43.0% of males and 43.2% of females were diagnosed with late-stage CRC. Social support, having children, and caffeine intake were predictors of CRC stage at diagnosis among males, while family history of CRC, pregnancy, hysterectomy, menopausal hormone therapy, lifetime number of Pap tests, and household physical activity were predictive of CRC stage at diagnosis among females. These findings highlight the importance of sex differences in susceptibility to advanced CRC diagnosis and can help inform targets for cancer prevention programs to effectively reduce advanced CRC and thus improve survival.

Highlights

Colorectal cancer (CRC) is the third most common cancer in Canada and the second leading cause of cancer-attributable deaths [1,2]
Alberta’s Tomorrow Project (ATP) is a prospective cohort study examining health, lifestyle, and psychosocial factors associated with the development and prevention of chronic diseases and cancer among healthy adults living in Alberta, Canada [41]
The distribution of CRC stage at diagnosis was similar among females, with 22.3%, 34.5%, and

Summary

Introduction

Colorectal cancer (CRC) is the third most common cancer in Canada and the second leading cause of cancer-attributable deaths [1,2]. Data from Canada [1,3] and other developed nations [4,5] indicate that CRC incidence and mortality are higher among males than females. In Canada, age-standardized incidence rates were estimated at 71.7 per 100,000 for males and 50.9 per 100,000 for females [1]. In Alberta, Canada, age-standardized incidence rates among males and females were estimated at 62.8 per 100,000 and 45.1 per. Coinciding with the aging population, it is expected that one in fourteen males and one in sixteen females in Canada will develop CRC in their lifetime [2]. Cancer staging identifies the severity of cancer at diagnosis according to the size of the tumour, and whether and to what extent it has metastasized to surrounding tissues. In Canada, the net 5-year relative survival of stage IV colon and rectal cancers is estimated at 11% and 12%, respectively, whereas the 5-year survival of stage I colon and rectal cancers is 92% and 87%, respectively [10]

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