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Men have higher levels of cancer incidence and mortality than women. Although this disparity is mainly due to their poorer use of primary prevention strategies, sex differences in early detection practices may also be a contributing factor. We reviewed evidence for differences in the prompt presentation of symptoms and the uptake of screening behaviours between men and women. We found men engage in self-examination less frequently, and are more likely to delay reporting cancer symptoms to a doctor. Evidence concerning their adherence to cancer screening was mixed, with some data showing that men may be as interested in attending screening as women.Delay in symptom presentation and less self-examination are probably due to men's lower levels of awareness of cancer, poorer knowledge of cancer warning signs, and relatively low contact with health professionals which might preclude opportunities to promote cancer detection behaviours. More data is needed about gender differences in screening uptake before concluding that special efforts are needed to encourage men to attend. Although aspects of the male gender role may conflict with participation in positive healthy behaviours and help seeking, efforts must be made to increase awareness, understanding and adherence among men if they are to share the health rewards screening and early detection can bring. ß 2005 WPMH GmbH. Published by Elsevier Ireland Ltd.Cancer incidence and mortality are higher for men than women for almost all the cancers that affect both sexes [1]. This has been largely attributed to sex differences in modifiable risk factors, such as smoking and alcohol consumption [1]. With improvements in treatment and the development of new screening technologies (e.g. for colorectal and lung cancer), secondary prevention is likely to play an increasingly important role in mortality reduction. Consequently, sex differences in uptake of screening or prompt presentation of symptoms could begin to make a significant contribution to mortality differentials. The example of colorectal cancer illustrates this argument. Colorectal cancer is the second highest cancer killer in the UK and at present men have slightly higher incidence and mortality rates than women. Screening for colorectal cancer has the potential to reduce mortality by as much as 33% [2]. If men fail to attend, gender differences in cancer mortality will increase dramatically.Although there is a widespread belief that men are reluctant participants in secondary prevention, there has been little systematic exploration of sex differences in behaviours such as the prompt presentation of suspicious symptoms to a doctor and use of cancer screening services. Research findings are scattered around the oncological and psychological literature although the review by Lanzt et al. 2001 is a notable exception [3]. The aim of this paper is to bring together and review this literature and to consider the implications for men's health.

Summary Background Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC. Methods The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete. Findings Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%) had metastasis at baseline. Pathway sensitivity was 50% (95% CI 37–63) for WB-MRI and 54% (41–67) for standard pathways, a difference of 4% (−7 to 15, p=0·73). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (93% [88–96]) and standard pathways (95% [91–98], p=0·45). Agreement with the multidisciplinary team's final treatment decision was 98% for WB-MRI and 99% for the standard pathway. Time to complete staging was shorter for WB-MRI (13 days [12–14]) than for the standard pathway (19 days [17–21]); a 6-day (4–8) difference. The number of tests required was similar WB-MRI (one [1–1]) and standard pathways (one [1–2]). Mean per-patient costs were £317 (273–361) for WBI-MRI and £620 (574–666) for standard pathways. Interpretation WB-MRI staging pathways have similar accuracy to standard pathways, and reduce the staging time and costs. Funding UK National Institute...

Background Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer. Methods The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete.

ObjectiveTo describe the experience and acceptability of whole-body magnetic resonance imaging (WB-MRI) staging compared with standard scans among patients with highly suspected or known colorectal or lung cancer.DesignQualitative study using one-to-one interviews with thematic analysis.SettingPatients recruited from 10 hospitals in London, East and South East England between March 2013 and July 2014.Participants51 patients (31 male, age range 40–89 years), with varying levels of social deprivation, were recruited consecutively from two parallel clinical trials comparing the diagnostic accuracy and cost-effectiveness of WB-MRI with standard scans for staging colorectal and lung cancer (‘Streamline-C’ and ‘Streamline-L’). WB-MRI was offered as an additional scan as part of the trials.ResultsIn general WB-MRI presented a greater challenge than standard scans, although all but four patients completed the WB-MRI. Key challenges were enclosed space, noise and scan duration; reduced patient tolerance was associated with claustrophobia, pulmonary symptoms and existing comorbidities. Coping strategies facilitated scan tolerance and were grouped into (1) those intended to help with physical and emotional challenges, and (2) those focused on motivation to complete the scan, for example focusing on health benefit. Our study suggests that good staff communication could reduce anxiety and boost coping strategies.ConclusionsAlthough WB-MRI was perceived as more challenging than standard scans, it was sufficiently acceptable and tolerated by most patients to potentially replace them if appropriate.Trial registration numberISRCTN43958015 and ISRCTN50436483.