Should Men Be Tested for Colorectal Cancer Earlier than Women?

A new study from researchers in Austria finds that men have a higher rate of advanced tumors compared to women in all age groups examined, suggesting that the age that individuals should undergo an initial screening colonoscopy should be sex-specific. The study appears in the September 28 issue of the Journal of the American Medical Association (JAMA). Although some studies have shown that men are at greater age-specific risk for advanced colorectal cancer than women, the age for referring patients to screening colonoscopy in average-risk patients is 50 years for both men and women

We asked Durado Brooks, MD, MPH, director of prostate and colorectal cancers for a response to the study.

 “The ‘gender gap’ in polyp prevalence described in this study has been demonstrated by other researchers. The current study is an important addition to this literature due both to the large size of the study population and because most or all study participants underwent screening (as opposed to diagnostic) colonoscopy.

“However, the applicability of these findings to the U.S. is somewhat limited, as the Austrian population is much more homogenous than the population of the United States. This is an important issue because there is a wealth of data demonstrating differences in the prevalence of both polyps and cancers between various racial and ethnic groups in the U.S. In particular, African Americans have an earlier age of onset and strikingly higher rates of colorectal cancer compared with other groups, as well as an increased prevalence of large polyps. The type of gender differences in polyp prevalence shown in the Austrian study have not been documented for African Americans.

“It is also important to note that, while polyps and polyp prevalence are an important factor in determining the appropriate age to initiate colorectal cancer screening, the incidence of colorectal cancer cases and deaths is of greater import. There is a significant increase in colorectal cancer incidence and deaths beginning at age 50 for both men and women in the U.S. Indeed, the incidence rate for men and women between the ages of 50-54 are twice those of individuals aged 45-49, and colorectal mortality nearly doubles in that interval as well. Based on this data, and the substantial decrease in colorectal cancer incidence and mortality attained over the past 2 decades, experts have agreed that 50 remains a reasonable starting age for men and women at average risk.

“U.S. women continue to lag behind men in colorectal cancer screening, and one of the biggest obstacles to increasing the use of well-proven lifesaving colon cancer screening tests is the belief that colorectal cancer is a ‘man’s disease.’ Unfortunately, this study could inadvertently feed into that belief. The Society will continue to reinforce the fact that colorectal cancer is the third leading cause of cancer death in both men and women, and not a ‘man’s disease. The fact that advanced adenomas and cancers are somewhat more common in men is widely known. However the numbers in women are still very significant, a point it is important to continue to emphasize.

“The idea of different screening recommendations based on individual factors (gender, age, race/ethnicity) has been explored during each review of the Society’s colorectal cancer guidelines. This study notwithstanding, there is limited evidence demonstrating that such customized recommendations will improve screening and outcomes. At the same time, there are concerns that such variable guidance could lead to confusion among patients and clinicians and paradoxically worsen colorectal cancer screening rates for some groups. This issue will be thoroughly evaluated in our future guidelines development activities.”

About David Sampson

I am the director of medical and scientific communications for the American Cancer Society national home office.
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