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Does sex matter in colon cancer screening?
NEW YORK |
NEW YORK (Reuters Health) - Middle-aged men are twice as likely as women to end up with a cancer diagnosis after colonoscopy, according to an Austrian study that challenges screening guidelines.
Guidelines currently advise that people at average risk of colon cancer start screening for the disease at age 50, regardless of gender.
But the new work, published in the Journal of the American Medical Association, shows a discrepancy of nearly 10 years between men and women in the development of colon and rectal tumors.
That means the same number of 55-year-old men would need to undergo colonoscopies -- in this case, around 80 -- to spot one cancer, as would be true for 65-year-old women. The same logic held true for the pre-cancerous growths called advanced adenomas, which doctors also scout for during colonoscopies.
However, a U.S. expert warned about making decisions regarding when to start screening based on the new findings.
"I would discourage women from looking at this study and saying, 'Gee, I can wait longer,'" said Dr. Michael LeFevre of the U.S. Preventive Services Task Force, a federally supported expert panel. "And I would discourage men from saying, 'Gee, I should start sooner.'"
The USPSTF recommends colon cancer screening between the ages of 50 and 75 using one of a number of types of tests. The advantage of colonoscopy, which costs around $3,000, is that it only has to be repeated once every ten years, as opposed to every year for the much cheaper stool test.
About one in 19 men develops colon cancer at some point and slightly fewer women do. The disease, which usually strikes older adults, is the third leading cause of cancer deaths in the U.S.
To get a better idea of when to start screening, Dr. Monika Ferlitsch and her colleagues looked at data from more than 44,000 Austrians, who'd had colonoscopies between 2007 and 2010.
Overall, they found 25 percent of men had adenomas, compared to only 15 percent of women. For full-blown tumors, those numbers were 1.5 percent and 0.7 percent, respectively.
At 0.8 percent, the rate of colon cancer among men aged 50 to 54, for instance, was twice that found among women in the same age group. That means 125 men would need to have a colonoscopy to find one tumor, versus 264 women.
While the reasons for the difference are still murky, Ferlitsch, of the Medical University of Vienna, said it could be linked to a higher degree of overweight and fatty liver disease among men -- both of which have been linked to colon cancer.
While her team suggests "screening recommendations concerning age should be reconsidered," Ferlitsch wasn't ready to give practical advice.
"It's a difficult question if we should delay screening in women or start it earlier in men," she told Reuters Health.
LeFevre said the USPSTF will take the new results into consideration as the panel updates its guidelines over the next couple of years.
Meanwhile, he told Reuters Health, "I think people can safely stick with the recommendation on the table to start screening at age 50, whether they are a man or a woman."
SOURCE: bit.ly/ox7Dtb Journal of the American Medical Association, September 27, 2011.
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