Sex differences in faecal occult blood test screening for colorectal cancer
Background This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening ef...
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| Veröffentlicht in: | British journal of surgery 2019-03, Vol.106 (4), p.436-447 |
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| creator | Koskenvuo, L. Malila, N. Pitkäniemi, J. Miettinen, J. Heikkinen, S. Sallinen, V. |
| description | Background
This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness.
Methods
In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed.
Results
From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women.
Conclusion
Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes.
Only of benefit in men |
| doi_str_mv | 10.1002/bjs.11011 |
| format | Article |
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This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness.
Methods
In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed.
Results
From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women.
Conclusion
Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes.
Only of benefit in men</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.11011</identifier><identifier>PMID: 30460999</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Blood tests ; Colorectal cancer ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - mortality ; Colorectal Neoplasms - surgery ; Early Detection of Cancer - methods ; Female ; Finland ; Gender differences ; Humans ; Male ; Middle Aged ; Occult Blood ; Original ; Risk Assessment ; Sex Factors ; Survival Analysis ; Tumors</subject><ispartof>British journal of surgery, 2019-03, Vol.106 (4), p.436-447</ispartof><rights>2018 The Authors. published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.</rights><rights>Copyright © 2019 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4091-e64e3e172ebaacd4aed31ce41d8b0637a6039b79609e255b6f585274eac025583</citedby><orcidid>0000-0001-8335-7942 ; 0000-0001-5394-4169</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.11011$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.11011$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30460999$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koskenvuo, L.</creatorcontrib><creatorcontrib>Malila, N.</creatorcontrib><creatorcontrib>Pitkäniemi, J.</creatorcontrib><creatorcontrib>Miettinen, J.</creatorcontrib><creatorcontrib>Heikkinen, S.</creatorcontrib><creatorcontrib>Sallinen, V.</creatorcontrib><title>Sex differences in faecal occult blood test screening for colorectal cancer</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness.
Methods
In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed.
Results
From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women.
Conclusion
Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes.
Only of benefit in men</description><subject>Aged</subject><subject>Blood tests</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - mortality</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Early Detection of Cancer - methods</subject><subject>Female</subject><subject>Finland</subject><subject>Gender differences</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Occult Blood</subject><subject>Original</subject><subject>Risk Assessment</subject><subject>Sex Factors</subject><subject>Survival Analysis</subject><subject>Tumors</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNpdkUtPxCAUhYnR6Di68A8YEjduqpfSlnZjohPfk7gYXRNKb7UTBhRaH_9eHB9RV0Dux8m55xCyw-CAAaSH9TwcMAaMrZAR40WepKwoV8kIAETCeMo3yGYIcwDGIU_XyQaHrICqqkbkeoavtOnaFj1ajYF2lrYKtTLUaT2YntbGuYb2GHoatEe0nb2nrfNUO-M86j6iWsW_foustcoE3P46x-Tu7PR2cpFMb84vJ8fTRGdQsQSLDDkykWKtlG4yhQ1nGjPWlDUUXKgCeFWLKjrENM_ros3LPBUZKg3xXfIxOfrUfRzqBTYabe-VkY--Wyj_Jp3q5N-J7R7kvXuWRV4KkfEosP8l4N3TEDeTiy5oNEZZdEOQ6UeIeQyRRXTvHzp3g7dxvUiVEai4EJHa_e3ox8p3zhE4_AReOoNvP3MG8qNAGQuUywLlydVseeHvp9ONDg</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Koskenvuo, L.</creator><creator>Malila, N.</creator><creator>Pitkäniemi, J.</creator><creator>Miettinen, J.</creator><creator>Heikkinen, S.</creator><creator>Sallinen, V.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8335-7942</orcidid><orcidid>https://orcid.org/0000-0001-5394-4169</orcidid></search><sort><creationdate>201903</creationdate><title>Sex differences in faecal occult blood test screening for colorectal cancer</title><author>Koskenvuo, L. ; Malila, N. ; Pitkäniemi, J. ; Miettinen, J. ; Heikkinen, S. ; Sallinen, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4091-e64e3e172ebaacd4aed31ce41d8b0637a6039b79609e255b6f585274eac025583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Blood tests</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - mortality</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Early Detection of Cancer - methods</topic><topic>Female</topic><topic>Finland</topic><topic>Gender differences</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Occult Blood</topic><topic>Original</topic><topic>Risk Assessment</topic><topic>Sex Factors</topic><topic>Survival Analysis</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koskenvuo, L.</creatorcontrib><creatorcontrib>Malila, N.</creatorcontrib><creatorcontrib>Pitkäniemi, J.</creatorcontrib><creatorcontrib>Miettinen, J.</creatorcontrib><creatorcontrib>Heikkinen, S.</creatorcontrib><creatorcontrib>Sallinen, V.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koskenvuo, L.</au><au>Malila, N.</au><au>Pitkäniemi, J.</au><au>Miettinen, J.</au><au>Heikkinen, S.</au><au>Sallinen, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex differences in faecal occult blood test screening for colorectal cancer</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2019-03</date><risdate>2019</risdate><volume>106</volume><issue>4</issue><spage>436</spage><epage>447</epage><pages>436-447</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Background
This analysis of patients in a randomized population‐based health services study was done to determine the effects of faecal occult blood test (FOBT) screening of colorectal cancer (CRC) in outcomes beyond mortality, and to obtain explanations for potential sex differences in screening effectiveness.
Methods
In the Finnish FOBT screening programme (2004–2011), people aged 60–69 years were randomized into the screening and control arms. Differences in incidence, symptoms, tumour location, TNM categories, non‐vital outcomes and survival in the screening and control arms were analysed.
Results
From 321 311 individuals randomized, 743 patients with screening‐detected tumours and 617 control patients with CRC were analysed. CRC was less common in women than in men (0·34 versus 0·50 per cent; risk ratio (RR) 0·82, 95 per cent c.i. 0·74 to 0·91) and women were less often asymptomatic (16·7 versus 22·0 per cent; RR 0·76, 0·61 to 0·93). Women more often had right‐sided tumours (32·0 versus 21·3 per cent; RR 1·51, 1·26 to 1·80). Among men with left‐sided tumours, those in the screening arm had lower N (RR 1·23, 1·02 to 1·48) and M (RR 1·57, 1·14 to 2·17) categories, as well as a higher overall survival rate than those in the control arm. Furthermore among men with left‐sided tumours, non‐radical resections (26·2 versus 15·7 per cent; RR 1·67, 1·22 to 2·30) and postoperative chemotherapy sessions (61·6 versus 48·2 per cent; RR 1·28, 1·10 to 1·48) were more frequent in the control arm. Similar benefits of screening were not detected in men with right‐sided tumours or in women.
Conclusion
Biennial FOBT screening seems to be effective in terms of improving several different outcomes in men, but not in women. Differences in incidence, symptoms and tumour location may explain the differences in screening efficacy between sexes.
Only of benefit in men</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>30460999</pmid><doi>10.1002/bjs.11011</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-8335-7942</orcidid><orcidid>https://orcid.org/0000-0001-5394-4169</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2019-03, Vol.106 (4), p.436-447 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Blood tests Colorectal cancer Colorectal Neoplasms - diagnosis Colorectal Neoplasms - mortality Colorectal Neoplasms - surgery Early Detection of Cancer - methods Female Finland Gender differences Humans Male Middle Aged Occult Blood Original Risk Assessment Sex Factors Survival Analysis Tumors |
| title | Sex differences in faecal occult blood test screening for colorectal cancer |
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