Gender-specific Colorectal Cancer: Epidemiologic Difference and Role of Estrogen

Hee Man Kim; Hyun-Soo Kim

doi:10.4166/kjg.2014.63.4.201

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Kim and Kim: Gender-specific Colorectal Cancer: Epidemiologic Difference and Role of Estrogen

Review Article

Korean J Gastroenterol 2014;63(4):201-208.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.4.201

Gender-specific Colorectal Cancer: Epidemiologic Difference and Role of Estrogen

Hee Man Kim, Hyun-Soo Kim

Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to: Hyun-Soo Kim, Department of Gastroenterology and Hepatology, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju 220-701, Korea. Tel: +82-33-741-1229, Fax: +82-33-741-1228, E-mail: hyskim@yonsei.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gender difference in the incidence of colorectal cancer is well known and has been supported by various epidemiologic studies. In Korea, women have lower incidence of colorectal cancer and adenoma, and the incidence in men has recently increased. Hormone replacement therapy in menopausal women is preventive of colorectal cancer but can cause cardiovascular diseases and breast cancer. Estrogen exerts diverse effects through estrogen receptors, ERα and ERβ. ERβ is associated with anti-pro-liferation and apoptosis. The ratio of ERα/ERβ is important in the protection and tumorigenesis of colorectal cancer. Therefore ERβ modulation has been investigated for preventing or treating colorectal cancer and avoiding adverse effects of estrogen at the same time. In addition, the gender-difference in the incidence of colorectal cancer should be taken into account when making guidelines on colorectal surveillance for Korean population.

Keywords: Colorectal neoplasms, Sex, Estrogens, Epidemiology, Hormone replacement therapy

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Table 1.

Korean Studies on the Prevalence of Colorectal Adenoma

No	Reference	Study period	Subjects		Prevalence of colorectal adenoma (%)
No	Reference	Study period	Age (yr)	Number	Total	Male	Female
1	8	1998–2004	≥50	2,435	30.2	41.0	20.7
2	9	2003–2004	−	3,951	35.2	39.7	22.9
3	10	2006–2009	20–79	19,372	−	34.5	20.0
4	11	2008–2010	−	1,526	34.6	42.6	24.1
5	12	2011–2012	−	1,375	−	53.5	32.7

Table 2.

International Comparison on Age-standardized Incidence of Cancers in Male¹⁴

Rank^a	Korea^b (2010)		Japan^c (2008)		USA^c (2008)		United Kindom^c (2008)
Rank^a	Type	Rate (/100,000)	Type	Rate (/100,000)	Type	Rate (/100,000)	Type	Rate (/100,000)
	All types of cancers	320.0	All types of cancers	247.3	All types of cancers	335.0	All types of cancers	280.8
1	Stomach	62.3	Stomach	46.8	Prostate	83.8	Prostate	62.1
2	Colon and rectum	48.6	Colon and rectum	41.7	Lung	49.5	Lung	41.6
3	Lung	46.5	Lung	38.7	Colon and rectum	34.1	Colon and rectum	36.2
4	Liver	36.0	Prostate	22.7	Bladder	21.1	Bladder	13.0
5	Prostate	25.3	Liver	17.6	Non-Hodgkin lymphoma	16.3	Non-Hodgkin lymphoma	12.0
6	Thyroid	18.3	Esophagus	10.6	Melanoma of skin	16.3	Melanoma of skin	11.1
7	Bladder	8.7	Pancreas	10.0	Kidney	16.1	Esophagus	10.0
8	Gallbladder etc.	8.1	Bladder	8.5	Leukemia	12.1	Leukemia	9.3
9	Pancreas	7.9	Kidney	7.5	Pancreas	8.0	Kidney	9.1
10	Kidney	7.8	Non-Hodgkin lymphoma	6.3	Lip, oral cavity and pharynx	7.4	Stomach	8.0

^a Ranked by the order of age-standardized incidence.

^b Estimated incidence rates of all types of cancers except for other skin (C44) to compare globally, using World Standard Population.

^c Estimated cancer incidence rates of 2008 using cancer registration data (GLOBOCAN 2008, IARC, 2010).

Table 3.

International Comparison on Age-standardized Incidence of Cancers in Female¹⁴

Rank^a	Korea^b (2010)		Japan^c (2008)		USA^c (2008)		United Kindom^c (2008)
Rank^a	Type	Rate (/100,000)	Type	Rate (/100,000)	Type	Rate (/100,000)	Type	Rate (/100,000)
	All types of cancers	264.7	All types of cancers	167.6	All types of cancers	274.4	All types of cancers	249.5
1	Thyroid	87.4	Breast	42.7	Breast	76.0	Breast	87.9
2	Breast	39.8	Colon and rectum	22.8	Lung	36.2	Colon and rectum	23.5
3	Colon and rectum	25.3	Stomach	18.2	Colon and rectum	25.0	Lung	23.7
4	Stomach	24.9	Lung	13.3	Corpus uteri	16.5	Ovary	12.8
5	Lung	14.3	Cervix uteri	9.8	Thyroid	15.1	Corpus uteri	11.1
6	Liver	10.2	Corpus uteri	7.6	Melanoma of skin	12.7	Melanoma of skin	10.5
7	Cervix uteri	10.6	Ovary	7.6	Non-Hodgkin lymphoma	a 11.5	Non-Hodgkin lymphoma	8.7
8	Ovary	5.7	Pancreas	6.1	Ovary	8.8	Cervix uteri	7.2
9	Gallbladder etc.	5.4	Liver	5.8	Kidney	8.7	Leukemia	5.9
10	Pancreas	4.9	Thyroid	4.4	Leukemia	7.9	Pancreas	5.2

^a Ranked by the order of age-standardized incidence.

^b Estimated incidence rates of all types of cancers except for other skin (C44) to compare globally, using World Standard Population.

^c Estimated cancer incidence rates of 2008 using cancer registration data (GLOBOCAN 2008, IARC, 2010).

Table 4.

Fiver-year Relative Survival Rate of Colorectal Cancer, 2006–2010¹⁵

	5-Year survival (95% CI)
	Male	Female
Total	74.5 (74.0–75.1)	69.9 (69.3–70.6)
Localized	94.2 (93.4–94.9)	91.1 (90.2–91.9)
Regional	79.1 (78.3–80.0)	76.3 (75.4–77.3)
Distant	18.3 (17.1–19.5)	18.3 (17.0–19.6)
Unknown	66.8 (65.2–68.4)	58.3 (56.5–60.1)

Extracted from the article of Jung KW, et al. (Cancer Res Treat 2013;45:162–171) with the original copyright author's permission.

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