Gender differences in the use of colorectal cancer tests among older Chinese adults
Introduction
Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world. It accounts for over 9.8% of all cancer incidence, is the third most common cancer worldwide and the fourth most common cause of death (Globocan, 2010). It affects men and women almost equally, accounting in 2008 for over 17.3% of the incidence and 8.2% of the mortality (610,000 deaths) (Globocan, 2010).
With its rapid economic growth over the past 20 years, China has become the second largest economy in the world (Barboza, 2010). There has been a growing trend of adopting Westernised dietary habits among wealthy Chinese, who are consuming more meat but less cereals and vegetables (Sung et al., 2008b). CRC is actually now the fourth leading cause of cancer death in China (The Ministry of Health of the People's Republic of China, 2010) and, given the vast population (over 1.3 billion), has become a substantial disease burden on the country, particularly in the more developed and wealthier regions.
Cancer screening increases the chance of early detection of cancer and is therefore a preventive measure of mortality. The three screening tests commonly used to screen CRC are the faecal occult blood test (FOBT), flexible sigmoidoscopy (FS) and colonoscopy. These tests are recommended by the Cancer Expert Working Group (CEWG) (2010) for populations at average risk, aged between 50 and 75. The recommended screening frequencies are: annual or biennial FOBT, FS every five years or colonoscopy every ten years (Cancer Expert Working Group on Cancer Prevention and Screening, Centre for Health Protection, Hong Kong Department of Health, 2010). However, the rate of uptake of CRC testing remains low. According to a local study, only 9.9% of participants reported that they had ever undergone CRC tests (Sung et al., 2008a).
Many studies have investigated factors that affect people's participation in CRC tests, and gender has always been identified as an important predictor. A review concentrating on older people of 65 or above showed that more than half of such studies had found women were less likely to be screened than men, regardless of the presence of health insurance (Guessous et al., 2010). Several studies have explored gender difference in CRC test rates among people aged 50 or above, and found that more men than women are currently tested for CRC (Brawarsky et al., 2003; Peterson et al., 2007; Wardle et al., 2005).
Several studies have reported that men prefer a different type of screening method from women. Four studies found that more men underwent FS or colonoscopy (Brawarsky et al., 2003; Green and Kelly, 2004; Griffin et al., 2009; Janz et al., 2003), while five others reported that more women used FOBT (Frederiksen et al., 2010; Green and Kelly, 2004; Ioannou et al., 2003; McQueen et al., 2006; Parente et al., 2009). Although such studies did show there was a difference, two reported that the results of gender difference in CRC test preference were not statistically significant (Griffin et al., 2009; McQueen et al., 2006).
Differences in the uptake of CRC test between genders may be explained in several possible ways. There is a belief that colorectal cancer is a male disease, with women feeling they are less vulnerable to the disease, and often expressing a fear of pain and embarrassment in the case of endoscopic screening. Moreover, preparations for the endoscopic procedure are a major barrier as more women than men believe that the degree of laxative intake is abusive and intolerable, and are therefore less likely to participate in CRC testing (Friedemann-Sánchez et al., 2007). On the other hand, men have also been considered less enthusiastic than women about health-promoting or disease-preventing behaviour in general. Men seem to have a lower level of health knowledge than women and are therefore less likely to be aware of the value of preventive behaviour (Beier and Ackerman, 2003).
Most cancer examinations are for sex-specific types, such as prostate, cervical or breast cancers, and the CRC test is the only on involving both genders. It is interesting to explore whether or not differences in the uptake rates of CRC testing exist between men and women in Chinese societies. In our previous study (So et al., 2012), we identified determinants associated with the uptake of CRC testing, including socio-demographics, health status, use of complementary therapy and health-related perceptions. Numerous studies have shown that recommendation from health professionals is a significant factor in influencing the uptake rate (Bellizzi et al., 2011; Brenes and Paskett, 2000; Gilbert and Kanarek, 2005; Palmer et al., 2011; Sung et al., 2008a). The present study aims to explore gender difference in the use of CRC tests among Hong Kong Chinese aged 50 years or more, with adjustment for their differences in the above determinants and for recommendations from health professionals. Furthermore, we also want to examine if the effects of those determinants and recommendations on the use of CRC tests vary between the two genders in this population.
Section snippets
Materials and methods
The methodology of the present study has been described in detail in our previous publication (So et al., 2012). In brief, it was a cross-sectional telephone survey conducted with a population consisting solely of Hong Kong Chinese residents aged 50 or above living in domestic households. Anonymous telephone interviews, using a structured questionnaire, were conducted by the telephone survey team of the Centre for Epidemiology and Biostatistics of the Chinese University of Hong Kong. Telephone
Socio-demographic characteristics
A total of 2004 participants (1002 of each gender) completed the survey and were included in the study (response rate = 67%). The gender-specific age distribution of the sample collected was comparable to the local general population in 2007 (Census and Statistic Department, 2007). The characteristics of the participants stratified by gender are shown in Table 1. Significant differences between genders were found in most socio-demographic areas. The proportion of males in the youngest (50–59
Discussion
In this study, we explored the gender difference in CRC testing among Hong Kong Chinese adults aged 50 years or more by means of a population-based survey. We found that the FS/colonoscopy uptake rates were respectively 14% and 10% for males and females aged 50 years or above; while the FOBT rate was 19% for both genders. These rates are consistent with other Chinese studies (Sun et al., 2004; Yip et al., 2006) but rather lower than those in other developed countries (Brawarsky et al., 2003;
Conclusions
This study is the first population-based work to explore gender differences in the uptake of FS/colonoscopy testing among Chinese adults aged 50 or above. The results showed that although males were more likely than females to have undergone such a test, the uptake rates in general were still low for both men and women in this average-risk population. Further efforts are clearly needed to educate the general public about the importance and benefits of the CRC test. Given their great influence
Conflict of interest
None declared.
Acknowledgement
The authors would like to thank all participants of this study. The study was supported by the departmental research fund from The Nethersole School of Nursing, The Chinese University of Hong Kong.
References (39)
- et al.
Correlates of colorectal cancer testing in Massachusetts men and women
Preventive Medicine
(2003) - et al.
Predictors of stage of adoption for colorectal cancer screening
Preventive Medicine
(2000) - et al.
Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis
European Journal of Cancer
(2006) - et al.
Colorectal cancer screening: physician recommendation is influential advice to Marylanders
Preventive Medicine
(2005) - et al.
Are gender differences in colorectal cancer screening rates due to differences in self-reporting?
Preventive Medicine
(2009) - et al.
Colorectal cancer screening barriers and facilitators in older persons
Preventive Medicine
(2010) - et al.
Predictors of colorectal cancer screening participation in the United States
The American Journal of Gastroenterology
(2003) - et al.
Colorectal cancer screening attitudes and behavior: a population-based study
Preventive Medicine
(2003) - et al.
A systematic review and meta-analysis of familial colorectal cancer risk
American Journal of Gastroenterology
(2001) - et al.
Knowledge and perceptions regarding colorectal cancer screening among Chinese—a community-based survey in Singapore
Preventive Medicine
(2007)
Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong – a population-based survey
European Journal of Oncology Nursing
Factors associated with colorectal cancer screening among Chinese-Americans
Preventive Medicine
Complementary and alternative medical therapy use among Chinese and Vietnamese Americans: prevalence, associated factors, and effects of patient–clinician communication
American Journal of Public Health
China Passes Japan as Second-largest Economy
Determinants of health knowledge: an investigation of age, gender, abilities, personality, and interests
Journal of Personality & Social Psychology
Prevalence of cancer screening in older, racially diverse adults: still screening after all these years
Archives of Internal Medicine
Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States
Cancer Causes and Control
Recommendations on Colorectal Cancer Screening
Women and Men in Hong Kong Key Statistics, 2007
Cited by (5)
Development and Validation of a Prognostic Tool for Identifying Residents at Increased Risk of Death in Long-Term Care Facilities
2019, Journal of Palliative MedicineLess barium enema, more colonoscopy: A 12-year nationwide population-based study in Taiwan
2019, Journal of the Chinese Medical AssociationContributing factors to colorectal cancer screening among Chinese people: A review of quantitative studies
2016, International Journal of Environmental Research and Public HealthDoes colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis
2015, Journal of Behavioral Medicine