Sex and gender-oriented colorectal cancer screening: a consensus study from the AIOM- GISEG working group

Gender medicine in oncology focuses on understanding the differences in cancer incidence, progression and responses to oncological treatments between men and women. Colorectal cancer (CRC) is a paradigmatic example of sex and gender disparities in incidence and prevalence, age of onset, pathogenesis, tumour location and responses to oncological treatments. However, despite growing evidence of these differences, there are no current clinical recommendations based on sex and gender, nor are there differentiated diagnostic-therapeutic pathways.

The objective of this consensus study was to identify areas of expert agreement regarding the potential appropriateness and clinical relevance of sex and gender-tailored colorectal cancer screening strategies on the basis of currently available evidence. A comprehensive literature review was conducted in order to examine any existing evidence on sex-and gender-related differences in CRC. Publications that were included in this review were manually searched in PubMed/Medline by using different combinations of relevant keywords. Based on synthesised evidence, a multidisciplinary panel of experts convened to develop consensus statements using the RAND/UCLA Appropriateness Method.

The findings highlighted significant disparities between men and women in incidence, age at onset, lesion distribution, participation rates, and barriers to screening, hence supporting the need for a more tailored approach in CRC screening strategies. Through a structured rating process and iterative discussion, the panel formulated a set of statements and actionable recommendations to enhance equity and effectiveness in CRC screening programs.

Core statements emphasize the importance of collecting and analysing sex-disaggregated data in screening registries, promoting further research to address existing knowledge gaps, tailoring communication strategies to gender-specific barriers and facilitators to improve screening adherence, considering potential differences between men and women in the optimal age and modality for CRC screening, within a framework of personalized and precision medicine.