Understanding and Managing Higher Rates of Colorectal Cancer in Men

Updated on June 11, 2024

Colorectal cancer (CRC) is now the third most diagnosed cancer in the U.S. in both women and men. The American Cancer Society estimates that more than 106,000 new colon cancer cases, 54,210 in men and 52,380 in women, and more than 46,000 new rectal cancer cases, 27,330 in men and 18,890 in women, will be diagnosed this year (2024). The lifetime risk of men getting CRC is one in 23, while the lifetime risk for women is one in 25. According to studies, one of the reasons for the disparity between men and women is that men feel screening, especially with an endoscopic scope, to be a threat to their masculinity. 

The Importance of Screening for Early Detection

Early detection is critical to survival rates. When patients aren’t diagnosed until the disease has advanced, treatment options are limited. When CRC is found early, the 5-year survival rate is 90%. This drops to less than 20% when found in the latter stages of the disease. 

Although non-invasive screenings like fecal occult blood and DNA stool tests are now readily available, colonoscopies remain the gold standard of screening. While alternative methods are better than no screening at all, they have been shown to miss more than half of all precancerous polyps and up to eight percent of colon cancers, and they have a 12% “false-positive” rate. These products can also give individuals a false sense of security and may cause them to put off a colonoscopy, which is the only procedure that can both detect and prevent cancer. 

In the U.S., one in every three patients eligible for a colonoscopy has never received one. 

CRC Risk Factors for Men

Although it is not entirely understood, men are more likely to die from CRC than women. As mentioned above, this may be due to men not being screened as often or as early as women. 

Risk factors for men are similar to those of women. The World Health Organization indicates that the top CRC risk factors include a sedentary lifestyle, a high intake of processed meat, a lack of fresh fruits and vegetables, smoking, excessive alcohol consumption, and obesity. With obesity, men appear to be at higher risk than women, although the reasons are unclear.  It is believed that men who have had radiation therapy for colon cancer may also be at higher risk of getting the disease. 

Age is another risk factor. Although the incidence of CRC is increasing in younger people, those over 60 are still at greater risk. The average age of colon cancer and rectal cancer diagnosis in men is 66 and 62, respectively. For women, the average ages are 69 and 63.    

Another risk factor is race. While CRC is the second leading cause of cancer-related deaths overall, it is the leading cause of for Black people, and Black men in particular. According to Cancer.net, “Black women are more likely to die from colorectal cancer than women from any other racial group, and Black men are even more likely to die from colorectal cancerthan Black women.”

CRC Symptoms

Recognizing the symptoms of CRC is vital. According to the MD Anderson Cancer Center, these symptoms are the same in men and women and include changes in bowel habits or painful movements, abdominal pain or stomach cramping, bloating, appetite changes, rectal bleeding, blood in stool, excessive fatigue, and unexplained weight loss. 

It is essential that primary care physicians educate their patients about the symptoms of CRC, which some may attribute to other causes. 

Screening Guidelines

For those at an average risk of CRC, the American Cancer Society recommends the following screening recommendations:

  • Ages 45-75: Colonoscopy every 10 years 
  • Ages 76-85: Selective testing based on personal preferences, life expectancy, general health, and prior screening history
  • Ages 85 and up: Screening is not recommended for this age group as the risks can outweigh the benefits

The above are general guidelines, but each individual should work with their physician to determine their risk and create a screening schedule based on that risk. 

Treatment Approaches

There are many types of CRC treatments, and all are based on the type and stage of the cancer at diagnosis. Standard treatments include surgery, chemotherapy, radiation, or targeted immunotherapy. Each of these treatments, or a combination of treatments, can be individualized to each patient’s case. 

The FDA recently approved new drug therapies to treat CRC, and many more are in the research or testing phase. In addition, numerous clinical trials and research programs are underway to test new types of screening and therapies. Genetics seems to hold a great deal of promise. 

Educating Patients

There are many myths surrounding colonoscopies, and it is important that physicians proactively dispel them, even if their patients don’t ask. One of these is that only people with active symptoms need a colonoscopy. While having active symptoms is certainly a reason to have one, so are age, heredity, diet, obesity, and other physical indications associated with greater CRC risk. 

One of the most significant barriers is the anxiety and perceived discomfort that come with prep day. Most patients have likely heard someone tell of their prep day experience, or they live with someone and have seen it firsthand. The important thing for them to understand is that there are numerous steps they can take to make the experience more comfortable. The website FIGHT Colorectal Cancer offers a number of prep-day tips that can help alleviate patient anxieties.

Patients also need to understand that the processes around colonoscopies are discreet and that clinicians are kind and will do all they can to make the patient feel comfortable, safe, and pain-free.

The Time for Action is Now

Helping men overcome their fear of colonoscopies should be top of mind for all primary care physicians, and the best way to do that is through education. Men need to understand the symptoms, their unique risks, and the importance of early detection. Part of the education should include dispelling the myths around the procedure and providing information about making prep day less distressful. 

While education about CRC is vital, physicians must also help guide their male patients in choosing a gastroenterologist. To ensure that every man has the knowledge and resources necessary to make informed decisions about his health, it’s imperative that we prioritize continuous education and support. Encouraging regular screenings can save lives by detecting colorectal cancer early when it is most treatable. Let’s commit to this crucial aspect of men’s health care, making prevention and early detection a shared responsibility.

Jonathan Rosenberg
Dr. Jonathan Rosenberg
Director of Clinical Research at GI Alliance of Illinois
Jonathan Rosenberg, MD, AGAF is Director of Clinical Research for GI Alliance of Illinois. He is also Medical Director for the North Shore Endoscopy Center and theRegional Director of Education for GI Alliance.