Cancer of the colon and rectum: potential effects of sex-age interactions on incidence and outcome

Abstract

Background: Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer have been under intensive investigation for the last three decades. Given that most of the sex-related differences reported were also age-related, this study sought to determine the potential effect of a sex-age interaction on colorectal cancer development and progression.

Material and methods: Statistical data on sex- and age-specific colon or rectal cancer incidence, disease stage and survival for white persons were derived from the United States Surveillance, Epidemiology and End Results (SEER) Program. Age-specific incidence rates in 2002-2006 were analyzed by 5-year age groups (45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84 years) in men and women. Sex differences were measured by calculating rate differences (RD) and rate ratios (RR). Equivalent analyses for a similar time period were performed for stage distribution and 5-year relative survival.

Results: Age-specific incidence rates were higher for men, for all life-time periods. However, the magnitude of the male predominance was age-dependent. The RR and RD did not remain constant over time: they increased gradually with age, peaked at 70-74 years, and declined thereafter. The distribution of stage at diagnosis was similar between men and women, but women seemed to have better survival, until the age of 64 years for colon cancer and 74 years for rectal cancer.

Conclusions: There seem to be significant age-related sex differences in the incidence of colorectal cancer, and maybe also in its prognosis.

Figure 1

Age-adjusted SEER incidence rates (per 100,000), 2002–2006 (17 areas), white, by sex.

Figure 2

(I) Age-specific SEER incidence rates (per 100,000), 2002–2006 (17 areas), white, by sex. (II) Male-to-female incidence rate ratio (RR) and incidence rate difference (RD).

Figure 3

(I) Stage distribution (SEER summary stage), 2000–2006 (17 areas), white, at age at diagnosis by sex. (II) Male-to-female stage-stratified incidence rate ratio (RR) and stage-stratified incidence rate difference (RD).

Figure 4

(I) 5-year relative survival rates, 1999–2005 (17 areas), white, at age at diagnosis by sex. (II) Male to female survival rate ratio (RR) and survival rate difference (RD).