Colorectal Cancer in Women

Studies have shown that colorectal cancer (CRC) incidence and mortality are slightly lower in women than in men.  There is evidence that women have a relatively low risk of CRC until they enter menopause, likely due to the protective role that estrogens have in the prevention of polyp formation.  Women are also protected against CRC through their lifestyle and diet because compared to men they generally smoke less tobacco, drink less alcohol, and eat a diet that is higher in fiber and lower in fat and red meat.

There may also be a gender difference in the location of CRC within the colon.  One study demonstrated that women had more neoplastic lesions in the proximal colon which would have been missed if only a flexible sigmoidoscopy had been performed (N Engl J Med 2005;352:2061-8).  This suggests that colonoscopy may be the preferred method of screening for CRC in women.

Did you know that men are more likely than women to undergo colorectal cancer (CRC) screening?  It is not clear if men are being referred more often for CRC screening than women or if men are more accepting of screening recommendations.  Currently, only about 45% of eligible women undergo CRC screening, rates which lag significantly behind screening rates for breast (80%) and cervical (70%) cancers.  CRC screening rates in women are correlated with access to health care, educational level, and Caucasian ethnicity.

Women report a greater concern about discomfort and embarrassment during a colonoscopy procedure.  Diverticular disease, longer length and tortuosity of the colon, and a history of abdominal surgery or radiation can make colonoscopy in women challenging.  However, we now have techniques we can use to improve colonoscopy in women.  For example, patient comfort and quality of the exam is greatly improved with the use of Propofol in the setting of monitored anesthesia care.  We also have the option of using thinner-diameter, more flexible scopes such as pediatric colonoscopes and upper endoscopes when indicated.  The quality of colonoscopy is greatly enhanced by the use of high definition videoendoscopes and split dosing of the colonoscopy preparation which improves visualization of the colon and minimizes missed lesions.  The new colonoscopy preparations are low-volume and more palatable than preparations of the past.  These methods, combined with adherence to screening guidelines, are important to the prevention of colorectal cancer.

• CRC is preventable
• Timely CRC screening is critical in saving lives
• CRC in women behaves differently than in men
• In women, a colonoscopy will find more lesions than a sigmoidoscopy
• Patient comfort is maximized with new colonoscopy preps, improved instruments, and the use of Propofol