Not an equal opportunity disease - a sex and gender-based review of colorectal cancer in men and women: Part I

This paper reviews the literature on colorectal cancer from a sex and gender-based perspective. Colorectal cancer is a major cause of death in the developed world, with rates increasing in developing countries. Although described by some writers as an ‘equal opportunity’ disease, it presents more risk to men than women. Both biological, or sex-linked factors, and gender-linked factors play a part in the aetiology of the disease, while gender differences in the use of screening and treatment also help shape the mortality gap between women and men for this condition. Without an appreciation of the part played by sex and gender in the risk of colorectal cancer, and without a gender-sensitive approach to screening in particular, it is possible that the mortality gap between men and women for this condition will widen in the future.     

International cancer patterns in men: geographical and temporal variations in cancer risk and the role of gender

The comparison of disease risk in populations stratified by certain demographic variables provides important clues as to the underlying causes of disease. There are fundamental variations in the risk of occurrence of different cancers by gender, area of residence, and time of diagnosis. Men are, for instance, at considerably higher risk of developing most of the common cancers that occur in both sexes, and there are substantial variations in the occurrence of particular cancers in different regions of the World. This paper attempts to highlight some of these remarkable variations using cancer incidence data by sex, area of residence and year of diagnosis, emphasising the strong evidence that many of the contrasts can be appropriated to a number of modifiable “environmental” factors.Rates of cancer occurrence in the developed world are double that of less developed regions, although risk patterns are of very different magnitude and direction depending on the cancer site examined. Lung cancer is the most common neoplasm in men globally, but is overshadowed by prostate cancer in certain westernised countries, notably in the U.S. Cancers of the colon and rectum are important in the developed world, whereas stomach and liver cancer are common in developing areas.Men have systematically higher rates than women for the vast majority of the tumours that develop in both sexes, with the exception of thyroid cancer. There are also huge variations in the extent of the inequality: men have notably elevated risks, relative to women, of developing tumours of the head and neck, bladder, lung, oral cavity and liver.In Europe, incidence trends of lung cancer tend to be declining in men, although there is substantial between-country variation. In women, lung cancer rates are systematically on the increase in most Western, Southern and European countries. Trends in prostate cancer are increasing, as are trends in colorectal cancer (in both sexes), although more noticeably in Southern and Eastern Europe. Stomach cancer continues to fall in most European areas. Bladder cancer is decreasing in both men and women, apart from in Eastern Europe, whereas cancers of the kidney and non-Hodgkin lymphoma are steadily increasing in both sexes.We have estimated that men have better and more readily achievable prospects of avoiding death from cancer since they have lower rates of gender specific cancers, that are probably hormonal in origin, then women. Tobacco consumption plays a dominating role in the excess risk of cancer in men but it is apparent that the male excess disease burden can be effectively reduced by various prevention measures. As well as avoiding (or quitting) smoking, these include, moderating alcohol consumption, avoiding obesity, undertaking regular physical exercise, and maintaining a diet high in fruit and vegetables. The adoption of a healthier lifestyle will be of considerable benefit to the general health of both men and women, with an expectation of a major reduction in the burden of cancer, as well as other major diseases.     

Screening for large bowel neoplasms in individuals with a family history of colorectal cancer.

Logistical problems associated with population screening for colorectal cancer are identified and the possibility of targeting screening to those with a familial predisposition to the disease is discussed. Evidence for a substantial genetic effect on the overall incidence of colorectal cancer is reviewed. The screening detection rate of colorectal neoplasms in relatives of patients with colorectal cancer has been shown to be higher than that expected in a non-selected population; the evidence that polypectomy will reduce future colorectal cancer risk in such individuals is explored. Recent advances in the molecular genetics of colorectal cancer susceptibility are reviewed; it is possible that a genetic test might be developed in the future which could identify at least a proportion of those at risk. Excluding financial considerations, the risk-benefit ratio of colonoscopy in a screened population is intimately related to the remaining risk of colorectal cancer in those who undergo the examination. At present, patients undergoing colonoscopy to investigate a positive faecal occult blood (FOB) test as part of a population-based screening programme include individuals with a familial predisposition as well as those without. About 20 per cent of all cases of colorectal cancer are associated with an obvious genetic predisposition, and the risk of cancer in their relatives is high. Because false positives occur with Haemoccult, the residual risk to the population who are FOB positive but do not have a familial trait may be sufficiently low that the dangers of colonoscopy could outweigh the potential benefits. Scotland has a high incidence of colorectal cancer, and analysis of recent Scottish incidence data shows an actuarial lifetime risk of developing this disease of one in 23 for men and one in 33 for women. As a family history of the disease increases that risk by two to four times and the neoplasms arise throughout the colon in such a group, there may be a case for offering colonoscopy to all first-degree relatives of those under 50 years of age at diagnosis, if not of all index cases of colorectal cancer.     

Cumulative risk for developing end-stage renal disease in the US population

The individual risk of developing end-stage renal disease (ESRD) and its overall impact on life expectancy is not known. This study's objectives were to determine the effect of ESRD on life expectancy for a cohort of 20-yr-olds and to compare this impact to that of several cancers for which population-based screening programs exist. A computer simulation, stratified by race (white, black) and by gender was used to calculate cumulative lifetime risk of ESRD, life-years lost to ESRD, and cumulative Medicare payments for ESRD. Similar calculations were made for breast, prostate, and colorectal cancer. The cumulative lifetime risk of ESRD for a 20-yr-old black woman is 7.8%. Equivalent risks for black men are 7.3%, white men 2.5%, and white women 1.8%. Lost years of life attributable to ESRD are 1.09, 1.10, 0.40, and 0.32 yr for black women, black men, white men, and white women, respectively. In blacks, ESRD is responsible for nearly as much loss of life-years as breast cancer in women and more loss of life-years than colorectal or prostate cancer in men. In addition, treatment costs for ESRD in this population are many-fold more expensive than cumulative treatment costs of these cancers. Exploring new screening and treatment strategies may be warranted to prevent ESRD, particularly in the US black population.     

Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery

Purpose: Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women.Methods: This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan–Meier (KM) to determine the impact of POAF in long-term mortality according to gender.Results: Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68–0.86] and 0.69 [0.60–0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women.Conclusion: In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.     

Men with colorectal cancer are predisposed to prostate cancer

Background: The objective of the present study was to investigate the relationship between colorectal and prostate cancer. Methods: All Victorian men who developed metachronous colorectal and prostate cancer with the first primary diagnosed between 1982 and 1993 were identified retrospectively from the Victorian Cancer Registry and were followed up to the end of 1995. Analyses were stratified by age group and years of follow up. The cause of death in those men who had prostate cancer following colorectal cancer was determined. The stage of colorectal cancer was compared between men with and without second primary prostate cancer and the grade of prostate cancer was compared with men who did not have a prior colorectal cancer. Results: Men who develop colorectal cancer are at increased risk of prostate cancer, with the greatest risk in men under the age of 65 (Relative risk ～2). Men with first primary colorectal cancer are more likely to develop prostate cancer than colorectal second primaries, and men who develop second primary prostate cancer are more likely to die of prostate cancer than colorectal cancer. Conclusions: Younger men diagnosed with colorectal cancer are at increased risk of prostate cancer. However, there is no direct evidence that screening for prostate cancer leads to a reduction in mortality. This should be considered when discussing long‐term follow up.     

Gender as a primary predictor of outcome after carotid endarterectomy

OBJECTIVE: Post hoc analysis results of the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study suggest that carotid endarterectomy (CEA) may not be as efficacious in women as it is in men. This study was undertaken for the evaluation of whether there is a difference between men and women in early postoperative outcome after CEA and whether such a difference is consistent across other predictors. METHODS: We conducted a retrospective review of all CEAs entered into our departmental registry between January 1, 1989, and November 30, 2000. A total of 3422 CEAs was performed in 3077 consecutive patients. The ratio of men to women was 2:1, and the ratio of patients who were asymptomatic to patients who were symptomatic was 2.3:1. The following in-hospital outcome data were analyzed: transient ischemic attack (TIA), stroke, mortality, combined TIA or stroke, and combined stroke or mortality. Univariate and multivariate analysis results of selected risk factors for an adverse perioperative event were assessed with generalized estimating equation analysis with backwards selection. The following risk factors were considered: gender, preoperative neurologic status, urgency of operation, type of arteriotomy repair, reoperative CEA for recurrent stenosis, history of cardiopulmonary disease, previous coronary artery intervention, simultaneous CEA and coronary bypass grafting surgery, renal failure, and diabetes. RESULTS: Univariate analysis results of gender differences revealed that women were at higher risk for a postoperative TIA or stroke (3.3% for women versus 2.1% for men; odds ratio [OR], 1.6; confidence interval [CI], 1.04 to 2.5; P =.03) and for postoperative stroke or mortality (3.1% for women versus 2.1% for men; OR, 1.6; CI, 1.04 to 2.5; P =.03). Multivariate analysis results showed that female gender was an independent predictor for a postoperative TIA or stroke (OR, 1.7; CI, 1.1 to 2.6; P =.03). Further analysis disclosed that women who were asymptomatic were at greater risk than were men for postoperative stroke or mortality (OR, 2.3; CI, 1.3 to 3.9; P =.003). Conversely, there was no gender association for postoperative stroke or mortality in the consideration of only patients who were symptomatic (OR, 1.0; CI, 0.45 to 2.1; P =.95). The interaction between women and preoperative symptoms approached significance (P =.07) with respect to postoperative stroke and mortality rate, which suggests that the gender effect could be influenced by the clinical presentation. CONCLUSION: The combined TIA or stroke and stroke or mortality rates are higher in women as compared with men in the postoperative period, but these risks remain acceptable when CEA is performed for appropriate indications. The interaction between symptoms and gender suggests that, in patients who are asymptomatic, women are more likely than are men to have early complications. However, there is no gender difference in patients who are symptomatic. Therefore, despite a low postoperative complication rate, CEA is appropriate in both women who are asymptomatic and women who are symptomatic only if the postoperative TIA, stroke, and mortality rates are appreciably lower than in the natural history of medical management of these patients.     

Colorectal cancer screening characteristics of patients presenting with symptoms of colorectal cancer and effect on clinical outcomes

IntroductionNational colorectal cancer screening, utilising a faecal occult blood test (FOBT), is now well established in the UK. The aim of this study was to define the screening characteristics of patients presenting to secondary care with symptoms of colorectal cancer and to assess the effect of screening outcome on subsequent symptomatic presentation.MethodsThis was a retrospective analysis of all patients of screening age presenting within one calendar year in a tertiary trust via a two-week wait (2WW) pathway owing to suspicion of colorectal cancer. Colorectal cancer related outcomes were compared between patients in the cohort who had previously accepted bowel cancer screening and patients who had previously declined bowel cancer screening. The primary endpoint was overall incidence of colorectal neoplasia. Secondary endpoints included incidence of colorectal malignancy, cancer related mortality, cancer related outcomes and polyp related outcomes.ResultsOverall, 2,227 patients presented via the 2WW pathway; 955 were aged 60–75 years. Among the latter, 411 (43%) had been screened previously and had a negative FOBT, and 544 (57%) had declined screening. Incidence of colorectal neoplasia did not differ between the two groups (113 [27%] vs 143 [26%], p=0.7). Of those with a negative FOBT and subsequent symptomatic presentation, 16 (3.9%) were diagnosed with a colorectal malignancy compared with 36 (6.6%) of those who declined screening and had subsequent symptomatic presentation (relative risk: 1.7, 95% confidence interval: 0.96–3.02, p=0.08). There were no differences between the two groups with regard to TNM (tumour, lymph nodes, metastasis) stage, Dukes’ stage, metastases, number of polyps or cancer related mortality (median follow-up duration: 20 months).ConclusionsThe incidence of colorectal neoplasia was similar among patients who previously had a negative FOBT and those who declined screening. There was a higher incidence of colorectal cancer detected among those who declined screening but it did not reach statistical significance. All other cancer and polyp outcomes were similar between the groups.     

Epidemiological trends in stage IV colorectal cancer

Epidemiological trends in stage IV colorectal cancer are concerning. As older adults in highly developed countries enjoy decreasing colorectal cancer incidence and mortality, younger patients are developing metastatic disease with increasing frequency, and profound systemic disparities persist in screening, treatment, and survival. Globally, the young populations of low- and middle-income countries are exposed to ever higher levels of colorectal cancer risk factors without colorectal cancer screening systems in place or ability to provide care, leading to an impending crisis. Scientific discoveries reveal the complex interplay between inherent, tumor-specific, and environmental risks, but the most profound factor underlying the epidemiology of metastatic colorectal cancer is inequality, globally and within the United States.     

Male osteoporosis: Epidemiology and pathophysiology

In men, osteoporosis is a prevalent problem that is underrecognized and undertreated. Men 50 years and older have a 13% lifetime risk for fracture. Hip and vertebral fractures are associated with significant functional impairment and increased mortality in men. The morbidity and mortality following a fracture is also greater in men than it is in women. By improving our knowledge on the pathophysiology of osteoporosis in men, better management strategies for this condition may be developed. In recent years, there has been greater awareness of the biomechanic factors that contribute to bone strength, which may explain some of the differences in fracture incidence between men and women. There is also growing evidence to support the key role of estrogens in maintaining bone health in older men, similar to women. This review highlights our current understandings on the epidemiology and pathophysiology of male osteoporosis and its related fractures, with particular focus on the determinants of bone strength and the role of sex hormones on bone metabolism in men.     

Height loss starting in middle age predicts increased mortality in the elderly

The purpose of this study was to determine the mortality risk among Japanese men and women with height loss starting in middle age, taking into account lifestyle and physical factors. A total of 2498 subjects (755 men and 1743 women) aged 47 to 91 years old underwent physical examinations during the period 1994 to 1995. Those individuals were followed for mortality status through 2003. Mortality risk was estimated using an age‐stratified Cox proportional hazards model. In addition to sex, adjustment factors such as radiation dose, lifestyle, and physical factors measured at the baseline—including smoking status, alcohol intake, total cholesterol, blood pressure, and diagnosed diseases—were used for analysis of total mortality and mortality from each cause of death. There were a total of 302 all‐cause deaths, 46 coronary heart disease and stroke deaths, 58 respiratory deaths including 45 pneumonia deaths, and 132 cancer deaths during the follow‐up period. Participants were followed for 20,787 person‐years after baseline. Prior history of vertebral deformity and hip fracture were not associated with mortality risk. However, more than 2 cm of height loss starting in middle age showed a significant association with all‐cause mortality among the study participants (HR = 1.76, 95% CI 1.31 to 2.38, p = 0.0002), after adjustment was made for sex, attained age, atomic‐bomb radiation exposure, and lifestyle and physical factors. Such height loss also was significantly associated with death due to coronary heart disease or stroke (HR = 3.35, 95% CI 1.63 to 6.86, p = 0.0010), as well as respiratory‐disease death (HR = 2.52, 95% CI 1.25 to 5.22, p = 0.0130), but not cancer death. Continuous HL also was associated with all‐cause mortality and CHD‐ or stroke‐caused mortality. Association between height loss and mortality was still significant, even after excluding persons with vertebral deformity. Height loss of more than 2 cm starting in middle age was an independent risk factor for cardiovascular and respiratory‐disease mortality among the elderly, even after adjusting for potential risk factors. © 2012 American Society for Bone and Mineral Research     

The effect of sex on disease stage and survival after radical cystectomy: a population-based analysis

BackgroundThe increased awareness regarding the sex gap in bladder cancer (BCa) care over the last decade may have resulted in more timely-wise referral patterns and treatment of female patients with BCa. Thus, we tested the association of sex with disease stage at presentation, as well as with cancer-specific mortality (CSM) after radical cystectomy (RC) in a contemporary cohort of patients with nonmetastatic urothelial bladder cancer (UCUB).MethodsWithin the Surveillance, Epidemiology, and End Results database (2004–2016), we identified 14,086 patients (10,879 men and 3,207 women) treated with RC for non-metastatic UCUB. Temporal trend, interaction analyses, logistic regression, cumulative incidence, and competing-risks regression analyses were used.ResultsOverall, 10,879 (77.2%) men and 3,207 (22.8%) women underwent RC between 2004 and 2016. Female gender was an independent predictor of non-organ-confined (NOC) UCUB at RC in multivariable analyses (odds ratio: 1.23; 95% confidence intervals [CI] 1.10–1.38; P < 0.001). While NOC rates in men decreased over time (from 54.8% to 45.7%; P < 0.01), NOC rates in women remained stationary (from 60.6% to 57.3%; P = 0.15) and the excess NOC rate between men and women increased from + 5.8% in 2004 to +11.6% in 2016. Moreover, in multivariable analyses adjusted for other covariates, female gender was an independent predictor of higher CSM after RC in NOC UCUB (HR: 1.14; 95%CI 1.04–1.24; P < 0.01), but not in localized UCUB (P = 0.06).ConclusionIt is worrisome that, while in men the rate of NOC is decreasing, NOC rates in females have not improved over time. Moreover, it is also worrisome that, despite adjustment for both pathological tumor and patient characteristics, female sex remains an adverse prognostic factor for CSM. Reassessment of referral, diagnostic, and treatment patterns aimed at eliminating these sex discrepancies appears warranted.     

Gender-associated risk factors for cardiac end points and total mortality after renal transplantation: post hoc analysis of the ALERT study

BACKGROUND: Female gender offers a cardioprotective effect over men in the general population, but is lost in the dialysis population. Whether renal transplantation restores the gender-dependent cardiac protection and whether there is a difference in the impact of risk factors is not known. METHODS: This is a post hoc analysis of pre-defined end points in the placebo arm in the Assessment of Lescol in Renal Transplantation (ALERT) study, a study in renal transplant recipients. Cox regression was performed to estimate the association between different risk factors at baseline and non-fatal myocardial infarction (MI) or cardiac death and total mortality, and specifically assess whether there are gender differences. RESULTS: The placebo arm included 1052 patients (mean age 50.1 +/- 11.1 yr, 65.3% males) with a mean follow-up of 65 months. The incidence of non-fatal MI or cardiac death was 10.9% vs. 7.9% (NS) and total mortality 13.3% vs. 12.8% (NS) in men and women. In multivariate analysis, previous coronary heart disease (CHD), diabetes, treatment for rejection and serum triglycerides were predictive for cardiac events in men, and low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio only in women. A slightly different risk-factor pattern appeared for total mortality. Diabetes, ECG abnormalities, plasma triglycerides, serum creatinine, time on dialysis and age predicted total mortality in men, while ECG abnormalities, LDL/HDL ratio and age were predictors in women. CONCLUSION: In this relatively low-risk population of renal transplant recipients, no gender difference in cardiac events or total mortality was observed, suggesting that female gender advantage regarding CHD is not restored following transplantation. The predictive value of risk factors differed in men and women.     

Osteoporosis: a rapid review of risk factors and screening methods

Osteoporosis is a significant problem in women and it is beginning to become a recognized etiology of morbidity and mortality in men. However, before reviewing any potential therapies, it is imperative that clinicians first gain adequate knowledge on the risk factors for osteoporosis and fractures, and the various screening methods that are utilized in clinical practice. For example, advancing age, hormonal status, lifestyle, and overall diet are just a few of the potential risk factors. The majority of the risk factors in men seem to parallel those that have already been well known in women. Heel ultrasound (HUS), dual-energy X-ray absorptiometry (DEXA), and quantitative computerized tomography (QCT) are the most popular and effective methods utilized for osteoporosis screening. All of these imaging tests contain an inherent number of advantages and limitations. This brief review serves as a simplistic but important primer to a condition that is increasing in prevalence in a diverse area of medical fields.     

Cardiovascular risk factors are differently associated with urinary albumin excretion in men and women

Cardiovascular morbidity and mortality is not equally distributed among genders, men being more affected than women. It is not clear whether this is only related to a higher prevalence of the cardiovascular risk factors or to a similar prevalence of the risk factors as in women but a greater vascular susceptibility to these risk factors in men. This was tested by studying the association between various cardiovascular risk factors and urinary albumin excretion (UAE) in a large cohort of male and female subjects. While the prevalence of smoking and hypercholesterolemia was comparable between the genders, obesity was more common in women, and diabetes and hypertension were more frequent in men. The prevalence of microalbuminuria was about twofold higher in men. Interestingly, for a given level of any risk factor, UAE was higher in men than in women. On multivariate analysis with UAE as the dependent variable, an interaction with gender was found for the risk factors age, body mass index, and plasma glucose. Thus, for a higher age, body mass index, and glucose, the UAE is significantly increased in men when compared with women. It is concluded that gender differences exist in the association between cardiovascular risk factors and UAE. This is consistent with a larger vascular susceptibility to these risk factors in men as compared with women.     

Women and Men in Sport Performance: The Gender Gap has not Evolved since 1983

Sex is a major factor influencing best performances and world records. Here the evolution of the difference between men and women’s best performances is characterized through the analysis of 82 quantifiable events since the beginning of the Olympic era. For each event in swimming, athletics, track cycling, weightlifting and speed skating the gender gap is fitted to compare male and female records. It is also studied through the best performance of the top 10 performers in each gender for swimming and athletics. A stabilization of the gender gap in world records is observed after 1983, at a mean difference of 10.0% ± 2.94 between men and women for all events. The gender gap ranges from 5.5% (800-m freestyle, swimming) to 18.8% (long jump). The mean gap is 10.7% for running performances, 17.5% for jumps, 8.9% for swimming races, 7.0% for speed skating and 8.7% in cycling. The top ten performers’ analysis reveals a similar gender gap trend with a stabilization in 1982 at 11.7%, despite the large growth in participation of women from eastern and western countries, that coincided with later- published evidence of state-institutionalized or individual doping. These results suggest that women will not run, jump, swim or ride as fast as men.

Key points

• Sex is a major factor influencing best performances and world records.
• A stabilization of the gender gap in world records is observed after 1983, at a mean difference of 10.0% ± 2.94 between men and women for all events.
• The gender gap ranges from 5.5% (800-m freestyle, swimming) to 36.8% (weight lifting).
• The top ten performers’ analysis reveals a similar gender gap trend with a stabilization in 1982 at 11.7%.
• Results suggest that women will not run, jump, swim or ride as fast as men.

Key words: World records, best performances, gender difference, elite sport     

Gender disparities in colorectal cancer screening: True or false?

To date, nearly all studies examining gender disparities in colorectal cancer screening report a lower endoscopic screening rate in women. Using a statewide claims database, gender differences in screening rates were analyzed in an attempt to validate gender disparities reported in prior survey-based studies. Procedural-level dataset containing all patient encounters for 2003 in which a colonoscopy or flexible sigmoidoscopy were performed was created. Procedures were selected using CPT codes and univariate analysis was performed using SAS v 8.0. Statewide for average-risk individuals 50 years or older, 65,232 endoscopic procedures were performed in 2003. The majority (83%) of endoscopic screening procedures were colonoscopies. Overall, the rate of screening in average-risk women 50 years or older (38 procedures/1000 people) was slightly lower than in men (42/1000) but not statistically significant. The rates of screening were higher in women before the age of 60 years and lower after the age of 60 years. No clinically significant difference was found in the type of screening procedure performed. Gender disparities in rates and types of colorectal cancer screening reported in prior survey studies are not validated in this patient encounter data study.     

Different disease profiles for women and men with abdominal aortic aneurysms.

OBJECTIVE: The overall aim with this study was to investigate causes of death and mortality rates for women and men treated for abdominal aortic aneurysm (AAA) in Sweden. MATERIALS AND METHOD: All patients treated for ruptured and non-ruptured AAA 1987-2002 in Sweden were identified in national registries (n=12917). Age, sex, diagnosis, surgical procedure and mortality were analysed on a patient specific level. Logistic regression and analysis of standardised mortality rates (SMR) were performed. RESULTS: Post operative mortality was similar between the sexes. Age (p<0.0001), and surgery for rupture (p=0.0005), but not gender (p=0.65) were significant risk factor for poor long term survival. SMR revealed increased risk for both sexes compared to the population with significantly higher values for women than men (2.26, CI 2.10-2.43 vs. 1.63, CI 1.57-1.68, p<0.0001). The higher risk for women could be explained by the higher risk for aneurysm related death (ie.thoracic or abdominal aorta) compared to men (Hazard ratio 1.57 vs. 1.0, p<0.0001). CONCLUSION: Women do not have an increased surgical risk compared to men, but treated women have an increased risk of premature death compared to men and women in the population. They also have a higher risk for aneurysm related death compared to men with AAA.     

我国开展结直肠癌筛查工作的必要性和可行性

近年来,我国结直肠癌的发病率和病死率明显升高,开展结直肠癌筛查是目前控制结直肠癌病死率最有效的手段.结直肠癌有明确的癌前病变--结直肠腺瘤,并且可以通过肠镜检查发现,这是结直肠癌能够早诊、早治的基础.筛查病变的步骤分为两步:第一步选择对象人群;第二步检查结直肠.筛查人群选择的准确性直接影响到筛查效率.常用的筛查方法有粪...