Sex differences in colorectal cancer mortality in Europe, 1955–1996

Fernández, Esteve; Bosetti, Cristina; Vecchia, Carlo La; Levi, Fabio; Fioretti, Francesca; Negri, Eva

doi:10.1097/00008469-200004000-00005

Cited by 55 publications

(36 citation statements)

References 25 publications

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“…This finding is supported by a recent study from Poland among more than 50 000 participants of a colonoscopy-based screening programme, where prevalence of advanced adenomas was higher at each age among men than among women, prompting the authors to the conclusion that gender-specific CRC-screening recommendations may be warranted (Regula et al, 2006). Furthermore, there are indications both from our analysis and from the literature (Fernandez et al, 2001) that the gender difference in the epidemiology of CRC has steadily increased during the last few decades. These results may therefore have important implications for the offer of CRC screening programmes and their optimisation in terms of cost effectiveness.…”

Section: Discussionsupporting

confidence: 83%

Gender differences in colorectal cancer: implications for age at initiation of screening

et al. 2007

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There is some variation regarding age at initiation of screening for colorectal cancer (CRC) between countries, but the same age of initiation is generally recommended for women and men within countries, despite important gender differences in the epidemiology of CRC. We have explored whether, and to what extent, these differences would be relevant regarding age at initiation of CRC screening. Using population-based cancer registry data from the US and national mortality statistics from different countries, we looked at cumulative 10-year incidence and mortality of CRC reached among men at ages 50, 55, and 60, and found that women mainly reached equivalent levels when 4 to 8 years older. The gender differences were remarkably constant across populations and over time. These patterns suggest that gender differentiation of age at initiation may be worthwhile to utilise CRC-screening resources more efficiently. With more than one million new cases and more than 500 000 deaths per year, colorectal cancer (CRC) is the third commonest cancer and the fourth commonest cancer cause of death worldwide (Parkin et al, 2005). Owing to its typically slow development, there is a large potential for reducing the burden of the disease by early detection and removal of precancerous lesions or early cancer stages. Various screening examinations, including faecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy have meanwhile been recommended by expert committees and implemented in screening offers in a number of countries (e.g. Winawer et al, 2003;Schmiegel et al, 2004;Malila et al, 2005;Smith et al, 2006). Regarding the age at initiation of screening, which is a crucial parameter for the effectiveness and cost-effectiveness of screening programmes (Vijan et al, 2001), there is some variation between countries (typically ranging from 50 to 60 years for the population at average risk). However, within countries, the same age of initiation is generally recommended for women and men, despite important gender differences in the epidemiology of CRC. In particular, age-specific CRC incidence and mortality are lower in women than in men, which implies that women reach comparable levels of CRC incidence and mortality at higher ages than men. This paper aims to address the question whether and to what extent these epidemiological differences might be relevant for defining age at initiation of CRC screening among women and men. METHODS Outcome measureWhen attempting to translate the gender differences in the epidemiology of CRC into gender-specific ages at initiation of screening, it is first necessary to define an appropriate outcome measure. In a screening programme that primarily aims at the early detection of CRC, as applies to FOBT-based screening, (cumulative) age-and sex-specific CRC incidence appears to be a natural choice. In a screening programme that aims to detect both CRC and its precursors (adenomas), as applies to endoscopy-based screening, the epidemiology of adenomas might also be considered. However, if the time...

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Section: Discussionsupporting

confidence: 83%

Gender differences in colorectal cancer: implications for age at initiation of screening

et al. 2007

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“…These results are in broad agreement with the descriptive epidemiology of colorectal cancer (dos Santos Silva and Swerdlow, 1996;Fernandez et al, 2000a), with the observation of an inverse relation between HRT and colorectal cancer risk (Herbert-Croteau, 1998;Fernandez et al, 2000b), and with biological hypotheses and experimental findings on the physiologic and molecular pathways of colorectal cancer (McMichael and Potter, 1985;Potter, 1999). A better understanding of this potential relation may help informed choice of contraception .…”

Section: Discussionsupporting

confidence: 81%

“…Over the last two decades colorectal cancer mortality has declined more in women than in men in several developed countries . This may be due to earlier or greater dietary improvements than in men, but exogenous hormones may also play a role (Fernandez et al, 2000a).…”

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confidence: 99%

Oral contraceptives and colorectal cancer risk: a meta-analysis

et al. 2001

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Summary Several studies have suggested an inverse association between use of combined oral contraceptives (OC) and the risk of colorectal cancer and here we present a meta-analysis of published studies. Articles considered were epidemiological studies published as full papers in English up to June 2000 that included quantitative information on OC use. The pooled relative risks (RR) of colorectal cancer for ever OC use from the 8 case-control studies was 0.81 (95% confidence interval (CI): 0.69-0.94), and the pooled estimate from the 4 cohort studies was 0.84 (95% CI: 0.72-0.97). The pooled estimate from all studies combined was 0.82 (95% CI: 0.74-0.92), without apparent heterogeneity. Duration of use was not associated with a decrease in risk, but there was some indication that the apparent protection was stronger for women who had used OCs more recently (RR = 0.46; 95% CI: 0.30-0.71). A better understanding of this potential relation may help informed choice of contraception.

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“…The relatively high colorectal cancer mortality in Argentina is consistent with a role of red meat (frequently consumed in this country) on colorectal carcinogenesis [23]. In Cuba, as in Costa Rica and Ecuador, colorectal cancer mortality rates (both all ages and truncated) were higher in women than in men, but there is no satisfactory explanation for the peculiar sex ratio in these countries [40,41]. It appears that Cuban women not only have higher rates of tobacco-(and alcohol-) related neoplasms, but also of colorectal cancer, which is moderately associated with alcohol and tobacco consumption, but is probably related to nutrition and diet [42].…”

Section: Intestines Chiefly Colon and Rectummentioning

confidence: 85%

Trends in cancer mortality in the Americas, 1970-2000

Bosetti¹

2005

Annals of Oncology

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Background: Data and statistics on cancer mortality over the last decades are available for most developed countries, while they are more difficult to obtain, in a standardized and comparable format, for countries of Latin America. Patients and methods: Age standardized (world population) mortality rates around the year 2000, derived from the WHO database, are presented for 14 selected cancers and total cancer in 10 countries of Latin America, plus, for comparative purposes, Canada and the USA. Trends in mortality are also given over the period . Results: In 2000, the highest total cancer mortality for males was observed in Argentina and Chile, with rates comparable to those of Canada and the USA, i.e. about 155/100 000. For women, Chile and Cuba had the highest rates in Latin America (114 and 103/100 000, respectively), again comparable to those of North America (around 105/100 000). These reflect the comparatively high mortality from cancer of the stomach (for Chile), lung and intestines (for Argentina) in men, and of stomach and uterus (for Chile), intestines and lung (for Cuba) in women. Colombia, Ecuador and Mexico had the lowest total cancer mortality for men, due to low mortality from stomach, colorectal and lung cancer. For women, the lowest rates were in Brazil and Puerto Rico, reflecting their low stomach and cervical cancer rates. In Argentina, Chile, Colombia, Costa Rica and Venezuela cancer mortality rates tended to decline, particularly in men. Rates were stable in Ecuador and Puerto Rico, and were increasing in Mexico and Cuba. Conclusions: Mortality from some common cancers (including colorectal and lung) is still low in Latin America compared with Canada and the USA, and decreasing trends have been observed in the last decades for some cancer sites (including stomach, uterus, lung and other tobacco-related cancers) in several countries. However, mortality from female lung and breast cancers has been increasing in most countries of Latin America, and several countries still show an extremely elevated mortality from cancer of the cervix. Selected neoplasms amenable to treatment, including testis and leukemias, also show unsatisfactory trends in Latin America.

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Sex differences in colorectal cancer mortality in Europe, 1955–1996

Cited by 55 publications

References 25 publications

Gender differences in colorectal cancer: implications for age at initiation of screening

Gender differences in colorectal cancer: implications for age at initiation of screening

Oral contraceptives and colorectal cancer risk: a meta-analysis

Trends in cancer mortality in the Americas, 1970-2000

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