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Citation/Abstract

Gender differences in colorectal cancer screening and incidence in large nationwide, population-based cohorts


2010 2010

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Abstract (summary)


Background. A few studies have reported gender differences along the colorectal cancer (CRC) continuum but none has done so longitudinally to compare a cancer and a non-cancer populations.

Objectives and Methods. To examine gender differences in colorectal cancer screening (CRCS); to examine trends in gender differences in CRC screening among two groups of patients (Medicare beneficiaries with and without cancer); to examine gender differences in CRC incidence ; and to examine for any differences over time. In Paper 1, the study population consisted of men and women, ages 67-89 years, with CRC (73,666) or without any cancer (39,006), residing in 12 U.S. Surveillance Epidemiology and End-Results (SEER) regions. Crude and age-adjusted percentages and odds ratios of receiving fecal occult blood test (FOBT), sigmoidoscopy (SIG), or colonoscopy (COL) were calculated. Multivariable logistic regression was used to assess gender on the odds of receiving CRC screening over time.

In Paper 2, age-adjusted incidence rates and proportions over time were reported across race, CRC subsite, CRC stage and SEER region for 373,956 patients, ages 40+ years, residing in 9 SEER regions and diagnosed with malignant CRC.

Results. Overall, women had higher CRC screening rates than men and screening rates in general were higher in the SEER sample of persons with CRC diagnosis. Significant temporal divergence in FOBT screening was observed between men and women in both cohorts. Although the largest temporal increases in screening rates were found for COL, especially among the cohort with CRC, little change in the gender gap was observed over time. Receipt of FOBT was significantly associated with female gender especially in the period of full Medicare coverage. Receipt of COL was also significantly associated with male gender, especially in the period of limited Medicare coverage.

Overall, approximately equal numbers of men (187,973) and women (185,983) were diagnosed with malignant CRC. Men had significantly higher age-adjusted CRC incidence rates than women across all categories of age, race, subsite, stage and SEER region even though rates declined in all categories over time. Significant moderate increases in rate difference occurred among 40-59 year olds; significant reductions occurred among patients age 70+, within subsite rectum, unstaged and distant stage CRC, and eastern and western SEER regions.

Conclusions. Persistent gender differences in CRC incidence across time may have implications for gender-based interventions that take age into consideration. A shift toward proximal cancer was observed over time for both genders, but the high proportion of men who develop rectal cancer suggests that a greater proportion of men may need to be targeted with newer screening methods such as fecal DNA or COL. Although previous reports have documented higher CRC screening among men, higher incidence of CRC observed among men suggests that higher risk categories of men are probably not being reached. FOBT utilization rates among women have increased over time and the gender gap has widened between 1998 and 2005. COL utilization is associated with male gender but the differences over time are small.

Indexing (details)


Subject
Public health;
Behavioral Sciences;
Epidemiology
Classification
0573: Public health
0602: Behavioral Sciences
0766: Epidemiology
Identifier / keyword
Health and environmental sciences, Psychology, Colorectal cancer, Gender differences, Health disparities, Incidence, Screening, SEER-Medicare
Title
Gender differences in colorectal cancer screening and incidence in large nationwide, population-based cohorts
Author
Abotchie, Peter Nathaniel
Number of pages
108
Publication year
2010
Degree date
2010
School code
0219
Source
DAI-B 71/05, Nov 2010
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781109739138
Advisor
Xianglin, Du L.
Committee member
Vernon, Sally W., Bartholomew, Leona K.
University/institution
The University of Texas School of Public Health
Department
Health Promotion & Behavioral Sciences Management
University location
United States -- Texas
Degree
Dr.P.H.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
3402111
ProQuest document ID
305227548
Copyright
Copyright ProQuest, UMI Dissertations Publishing 2010
Document URL
http://search.proquest.com/docview/305227548