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Why is colon cancer more common in men than women? – Previously known risk factors only partially explain the increased occurrence

Increased risk: men are more likely to develop colon cancer than women – this is known. But known risk factors such as diet or lifestyle can only partially explain these gender-specific differences, as a study has now shown. What other causes make men more susceptible to colon cancer remains a mystery for the time being. Perhaps the hormones have more influence than previously thought.

Colon cancer is one of the most common types of cancer worldwide. In Germany alone, around 55,000 people develop it every year, including significantly more men than women. Risk factors include smoking and a high consumption of red meat. Both are more common in men than in women. In studies, scientists have also found the first indications of hormonal influences on colon cancer growth – albeit in fruit flies.

On the trail of gender differences

However, it has not yet been clear whether known risk and protective factors can fully explain the gender differences in colorectal cancer risk. To answer this question, a team led by Tobias Niedermaier from the German Cancer Research Center (DKFZ) in Heidelberg has now evaluated the data of almost 16,000 men and women between the ages of 55 and 79 who had a colonoscopy to prevent colon cancer.

“We took into account the most important known and suggested risk factors,” report the researchers: “Age, family history of colon cancer, diabetes, previous colonoscopy, intake of aspirin and statins, smoking, alcohol consumption, body mass index (BMI), height , physical activity, consumption of red and processed meat, fruits and vegetables, whole grains, and finally the use of hormone replacement therapy in women. “

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Cancer rate cannot be explained by risk factors alone

A colonoscopy revealed that 141 men (1.8 percent) and 78 women (one percent) had colon cancer. A further 1,049 men (13.4 percent) and 591 women (7.2 percent) were diagnosed with an advanced adenoma in the intestine, a mostly benign tumor that can, however, be a precancerous stage. In both colon cancer and advanced adenomas, men were affected almost twice as often as women.

Niedermaier and his colleagues now calculated the extent to which the risk and protective factors recorded can explain this different distribution. “Many of the risk and protective factors differed significantly between men and women,” the researchers said. “For example, more men were diabetic, smoked and drank more alcohol more often, were overweight more often, did less exercise and ate less healthy food.”

All of these factors taken together, adjusted for age, could explain 47 percent of the increased risk for men. “Conversely, this means that we do not yet know the causes for the other half of this excess risk,” says Niedermaier’s colleague Hermann Brenner.

Hormones may be more important than expected

But where could the reason lie? A previously underestimated protective factor could be the female hormones. “Compared to women who have never taken hormone replacement therapy, the risk of men was less increased than compared to women with hormone replacement therapy,” said the researchers. “This suggests that hormonal factors play an important role in colorectal cancer risk, which could explain, to some extent, the remaining excessive risk for men.”

In order to take this factor into account more closely, they recommend collecting data on pregnancy, the use of birth control pills, breastfeeding, and the beginning and end of menstrual periods in future studies. “A better understanding of the role of hormonal factors throughout life could help explain the remaining ‘gender gap’,” the researchers write.

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Early detection is important – especially for men

A precise knowledge of the individual risk factors can also help with the decision for early detection offers. “In any case, our results show once again how important it is, especially for men, to take advantage of the options for colorectal cancer screening, to carry out stool tests or to opt for a preventive colonoscopy,” says Brenner. (International Journal of Cancer, 2021, doi: 10.1002 / ijc.33742)

Source: German Cancer Research Center

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