Gender differences in colorectal cancer screening in Central Italy

Background Colorectal Cancer (CRC) is the second leading cause of cancer death; its incidence and mortality can be effectively reduced with the spread of screening programs addressed to both genders. Some studies suggest that the increased mortality risk of males is related to a lower adherence to CRC screening. The aim of this study is to analyze time trends and gender differences in adherence to CRC screening in an area of central Italy. Methods We collected data for Arezzo province (Tuscany Region) covering the period 2006–2013 on: 1) compliance to fecal occult blood (FOBT) test invitation; 2) FOBT positivity rates; 3) attendance to colonoscopy. All data were stratified by sex,age group (50-54, 55–59, 60–64, 65–69, 70+) and for the history of screening (first and subsequent invitations). The non-parametric test of Cuzick was used for the statistical analysis of time trends, while data comparison between groups was carried out by applying Chi-square test. The statistically significant level was fixed at p < 0,05. Results The total average compliance in the study period was 58,2% with a significant decreasing trend (p = 0,037)of participation. Men underwent to FOBT less than women(56,2% vs 60,1; p < 0,01), for all the years except 2007(p = 0,41). Stratifying data by age and history of screening, the males-females difference lost significance in the oldest age-group (>65) and in the adherence to subsequent invitations. FOBT positive rates were higher in males(p < 0.01) and in the older age groups in both genders. Women showed a lower, although not significant, attendance to colonoscopy (70,7% vs 71,3%). Conclusions The findings showed a decreasing trend of participation in CRC screening. In line with the existing literature, a lower rate of adherence was found amongst men compared to women and in the younger age groups. Ad hoc studies and targeted interventions are needed to better understand and minimize gender specific obstructing factors and then increase CRC screening uptake. Key messages There is a significant gender inequity in CRC screening utilization, with the less adherent population represented by males in the youngest age group (50-54 ys) argeted and differentiated by gender interventions are age group (50-54, 55–59, 60–64, 65–69, 70+) and for the history of screening (first and subsequent invitations). The non-parametric test of Cuzick was used for the statistical analysis of time trends, while data comparison between groups was carried out by applying Chi-square test. The statistically significant level was fixed at p < 0,05. Results The total average compliance in the study period was 58,2% with a significant decreasing trend (p = 0,037)of participation. Men underwent to FOBT less than women(56,2% vs 60,1; p < 0,01), for all the years except 2007(p = 0,41). Stratifying data by age and history of screening, the males-females difference lost significance in the oldest age-group (>65) and in the adherence to subsequent invitations. FOBT positive rates were higher in males(p < 0.01) and in the older age groups in both genders. Women showed a lower, although not significant, attendance to colonoscopy (70,7% vs 71,3%). Conclusions The findings showed a decreasing trend of participation in CRC screening. In line with the existing literature, a lower rate of adherence was found amongst men compared to women and in the younger age groups. Ad hoc studies and targeted interventions are needed to better understand and minimize gender specific obstructing factors and then increase CRC screening uptake