Sex-based Disparities in Colorectal Cancer Screening

Abstract

Research suggests that recurrence and survival from colorectal cancer are worse in men than in women but the causes for this are unclear. Our aims were to (1) assess for sex differences in colorectal cancer screening (CRCS) within a large, contemporary population-based sample in California; and (2) examine the impact of income, education, and insurance status on sex differences in CRCS. Screening-eligible patients were identified from the 2007 US California Health Interview Survey. Up-to-date, CRCS was defined as fecal occult blood test within 1 year, flexible sigmoidoscopy within 5 years, or colonoscopy within 10 years. Logistic regression models were constructed to evaluate the relationship between sex and CRCS. Stratified analyses on the basis of self-reported income (low vs. high), education (≤ high school vs. > high school), and health insurance status (insured vs. uninsured) were performed to determine if sex differences in screening were modified by these parameters. In total, 11,260 men and 17,705 women were identified: mean ages were 65 and 66 years, respectively, and 63% were white in both the sexes. In the entire cohort, only two thirds of men and women reported undergoing up-to-date CRCS. Women had decreased odds of CRCS than men, after adjusting for potential confounders. Stratified analyses indicated that sex disparities in CRCS persisted among the insured, educated, and high-income earners. Women are less likely to undergo CRCS than men, but poor health care access is associated with low CRCS in both the sexes. Conventional strategies aimed at improving health care access should also include sex-specific interventions that raise awareness about preventive care to most effectively optimize CRCS.