The fate of unscreened women in colon cancer: impact on staging and prognosis.
BACKGROUND
Several nationwide reports show lower female participation in colon cancer screening. We therefore assessed for outcome differences in women of screening age presenting for surgical treatment of colon cancer patients.


METHODS
All patients over 50 years undergoing surgery for first-onset colon cancer at Massachusetts General Hospital (2004 to 2011) were included. Differences between (unscreened) women and the remaining population in presentation characteristics and subsequent morbidity and mortality were assessed.


RESULTS
We included 919 patients (49.1% female). Women were less often diagnosed through screening (26.4 vs 32.7%, P = .036). Unscreened women were at significantly higher risk (all P < .001) for having high-grade tumors (Relative risk [RR] = 1.61), lymph node metastasis (RR = 1.36), and distant metastasis (RR = 2.26) on pathology, leading to higher colon cancer-related mortality (RR = 1.72).


CONCLUSIONS
Unscreened women present with more advanced colon cancer and higher mortality, confirming that disparities in screening lead to ever-increasing disparities in outcomes.
Division of General Surgery and Gastrointestinal Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA.
Ramzi
R
Amri
Division of General Surgery and Gastrointestinal Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA.
Liliana G
LG
Bordeianou
Division of General Surgery and Gastrointestinal Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA.
Patricia
P
Sylla
Division of General Surgery and Gastrointestinal Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA. Electronic address: dberger@mgh.harvard.edu.
David L
DL
Berger
D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
Baseline characteristics; Colon cancer; Outcomes; Screening; Sex disparities; Surgical stay characteristics