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Men Face Higher Colon Cancer Risk

But the finding is no reason to screen women later, experts say

WEDNESDAY, Nov. 1, 2006 (HealthDay News) -- A new study finds that polyps linked to colon cancer are 73 percent more common in men than in women, leading researchers to suggest that colorectal cancer screening guidelines be changed.

For example, perhaps women might want to start their screening at a later age, suggested the Polish authors of a paper published in the Nov. 2 issue of the New England Journal of Medicine.

Other experts objected to the idea, however.

"Everybody needs to get screened," said Dr. Jerald Wishner, director of the colorectal cancer program and colorectal surgery at Northern Westchester Hospital in Mt. Kisco, New York. "The worst thing that could happen is for people to interpret that we don't have to worry about women."

"Seeing the precursors to colon cancer more in men than in women -- that's been out there for a long time. But I would have a problem focusing screening more on men than women because colon cancer and polyps are still very common in women," Wishner added.

"There have been some minimal differences between men and women, but I don't know that there's enough information to start changing guidelines," added Dr. Andrejs Avots-Avotins, associate professor of internal medicine with the Texas A&M Health Science Center College of Medicine. "Colon cancer is an equal-opportunity cancer. We shouldn't be characterizing men and women differently," he said.

Colorectal malignancies are the second leading cancer killer in the United States. Unlike many cancers, however, the disease is largely preventable through detection of precancerous polyps, such as those discussed in this study.

The American College of Gastroenterology (ACG) currently recommends that average-risk individuals start screening at age 50. The preferred method is a colonoscopy once every 10 years. Other methods are available but have to be performed more frequently.

Research presented just last week at the ACG annual meeting found that increased use of colonoscopy and other screening is having the intended effect: a significant drop in colon cancer rates in the United States over the past two decades.

Those recommendations are based only on age and family history of cancer, not gender.

It's well known that the prevalence of polyps are higher in men than in women, although lifetime colorectal cancer rates are similar between the genders.

In the study, a team from Maria Sklodowska-Curie Memorial Cancer Center in Warsaw looked at data on over 50,000 people 40 to 66 years old who were participating in a colorectal-cancer screening program using colonoscopy in Poland. People 40 to 49 were eligible only if they had a family history of colon cancer. The remainder of the participants were of average risk.

Almost 6 percent of participants aged 50 to 66 had advanced neoplasia (colon lesions or polyps), as did 3.4 percent of participants aged 40 to 49. But men were 73 percent more likely to have advanced neoplasia than women.

In each age group studied, the number of people who would need to undergo colorectal cancer screening in order to detect one advanced neoplasia was significantly lower in men than in women, even when age and family history were similar.

The fact that the paper comes out of Poland, where incidence of colorectal cancer and diet are different from the United States, makes it hard to translate the findings for American patients, Wishner said.

He wasn't swayed by cost-effectiveness arguments, either.

"I'm always wary of things that look at the cheapest way as opposed to the best way because we're talking about cancer," Wishner said. "Which person out there wants to be the one that slips through the cracks because it's too expensive to find everyone with cancer?"

Colonoscopy resources are limited, according to Avots-Avotins, so it's possible that "this might be one way to risk-stratify." Still, he said, "I'm not sure it's enough to warrant changes."

More information

Learn more about colorectal cancer at the U.S. Centers for Disease Control and Prevention.

SOURCES: Jerald Wishner, M.D., director, colorectal cancer program and colorectal surgery, Northern Westchester Hospital, Mt. Kisco, N.Y.; Andrejs Avots-Avotins, M.D., Ph.D., associate professor, internal medicine, Texas A&M Health Science Center College of Medicine and gastroenterologist, Scott & White Hospital, Temple, Tex; Nov. 2, 2006, New England Journal of Medicine
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