How Colon Cancer Is Different in Men

Senior man gestures while speaking with a healthcare provider.

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In the United States, colon cancer is the fourth most common type of cancer diagnosed each year. Colon cancer occurs in both men and women but it is more common in men, and in Black men in particular.

Overall, for every 100,000 men, 43.7 are expected to be diagnosed with colon cancer per year (compared to 33.6 women). Unfortunately, colon cancer is the second most deadly cancer, with 16.3 men of every 100,000 dying from it each year (compared to 11.5 women).

With all cancers, there are many reasons why there are differences in how men and women are affected. In some cases, this may have to do with biological differences such as anatomy or hormone production.

In others, there can be lifestyle factors or disparities in care that can influence how many men or women develop that cancer and experience different outcomes. Variations in diet and lifestyle choices, as well as access to care and cultural attitudes surrounding cancer screening, may all contribute to how men and women are affected differently by colon cancer.

All of these factors come together in a complicated mesh to drive the increased risk of developing colon cancer, and of dying from it, in men. 

Signs and Symptoms

The signs and symptoms of colon cancer are essentially the same in both men and women. The location of the tumor, however, may have an effect on some symptoms. For instance, a tumor lower in the digestive tract may cause bright red blood in the stool, while one that is higher up may cause stools to be tarry or black.

While they may vary slightly based on the location of the cancer in the colon, the typical symptoms of colon cancer include:

The signs and symptoms of colon cancer can be similar to those caused by other conditions that are more common, such as a viral or bacterial infection, or hemorrhoids. This is why it is important to go over changes in bowel movements with a doctor.

Blood in the stool is never normal and should be discussed with a physician, even when there is already a diagnosis of a condition like hemorrhoids or inflammatory bowel disease (IBD).

The symptoms of colon cancer that men experience may differ slightly from those in women. This is because, in men, cancer in the last part of the large intestine (the sigmoid colon) and in the rectum are more common. For women, cancer tends to be located further up in the large intestine (where it is more challenging to diagnose).

Colon cancer in the sigmoid colon or the rectum could cause symptoms such as blood in the stool or a persistent feeling of needing to use the toilet. These symptoms may become bothersome earlier in the course of the disease. This could lead patients to seek medical care and get checked out sooner than if the cancer is located higher up in the colon.

With colon cancer, early detection is important for successful treatment. The symptoms of the more common types of colon cancer in men may have the effect of catching the cancer in an earlier stage. Men are thus slightly more likely to be diagnosed with colon cancer at stage 1 than women, 16% of whom are diagnosed at stage 1. Overall, 18% of men are diagnosed at stage I, 27% at stage II, and 31% at stage III.

Even if it is diagnosed at an earlier stage, however, colon cancer is still more deadly in men than it is in women. One of the reasons is differences in hormones, because female hormones may offer some protection when it comes to colon cancer.

Lifestyle, including a pro-inflammatory diet, obesity, and lack of exercise, also play a role. These factors negatively affect men more than they do women when it comes to increasing the risk of colon cancer.

Cancer Rate in Men

In the United States, men of all ethnicities develop colon cancer in greater numbers than do women. However, Black men develop colon cancer at the highest rate among the ethnicities studied. Overall, the rate of colon cancer is falling about 2% each year, though there is a worrying trend of younger people being diagnosed.

There are risk factors for colon cancer that can't be changed, such as age, genetics, and having IBD or a condition that causes the growth of polyps. There are, however, several other factors that, together, may give a bigger picture as to why men are more affected by colon cancer than women.

Obesity

The rate of obesity in men, including Black men and Hispanic men, is increasing in the United States. Studies have shown that obesity is a factor in developing colon cancer. People who have a higher body mass index and waist circumference have a greater risk of developing colon cancer. This was found to be true in dozens of studies done in several countries.

A lack of physical activity is also associated with an increased rate of colon cancer. Most people in the United States do not reach the level of physical activity recommended, putting them at risk for cancers that are associated with inactivity.

Tobacco Use

Smoking tobacco cigarettes is another known risk factor for the development of colon cancer. The number of adults who smoke in the United States is decreasing. Smoking is more common in men than it is in women, however, especially among older men.

Men also tend to smoke more cigarettes per day and for more years than women do. Cancer on the left side of the colon tends to be more common in men who smoke.

Alcohol Consumption

Men have higher rates of alcohol consumption, including binge drinking, than women do. Alcohol consumption is a contributing factor to the development of colon cancer. Of particular concern is consuming more than two alcoholic drinks per day, which is associated with a higher risk level.

Red and Processed Meat Consumption

There is some evidence that eating a diet higher in red meat (beef) and processed meats (such as sausage, lunch meat, and hot dogs) is associated with a higher risk of colorectal cancer. However, the exact nature of how much risk is involved is not well understood.

In general, men are more likely to have a diet that is higher in these types of food, which may contribute to higher cancer rates.

IBD (Crohn's Disease and Ulcerative Colitis)

Having a diagnosis of IBD, and ulcerative colitis in particular, is a factor in developing colon cancer. The risk increases after eight years of having the disease. How well the IBD is managed also plays a role. Continuous inflammation from IBD that is not well managed is more closely associated with colon cancer.

Having disease throughout the colon (called extensive colitis or pancolitis) is also connected to increased risk. In the United States, men and women develop IBD in similar numbers. Therefore, IBD is not a risk factor that is specific to men, but it is significant, since IBD is lifelong.

Precancerous Lesions (Polyps)

Colon cancer begins with growths on the interior walls of the colon called polyps. When polyps are removed during a colonoscopy, they are no longer a cancer risk. Men tend to develop polyps in their colon at younger ages than do women.

Colon polyps are slow-growing, but they may develop in some people who have not yet reached the age for a colon cancer screening. One study showed that men may start developing polyps, on average, 10 years before women do.

Polyps are not a risk factor that can be changed, but screening for colon cancer may help find and remove them before they become cancerous (malignant).

Hereditary Conditions

Another factor that influences the risk of colon cancer are rare conditions that cause the growth of polyps. These include hereditary nonpolyposis colorectal cancer (Lynch syndrome), familial adenomatous polyposis (FAP), Gardner's syndrome, MYH-associated polyposis (MAP), Peutz-Jeghers syndrome, and serrated polyposis syndrome.

Having a family history of one of these conditions is important in assessing the risk for colon cancer. Most of these conditions appear to affect men and women similarly. However, men with Lynch syndrome have a higher risk of developing colon cancer than do women with the same condition.

Cancer Survival in Men

While screening is an important tool in finding colon cancer early, many adults in the U.S. do not receive any screening. Almost 30% of adults have never been screened for colon cancer using any approved test.

Not having any health insurance and not having a regular health care provider are major reasons why people do not have their recommended screening tests. Men, people who live outside of urban areas, and people of Hispanic, American Indian, or Alaska Native heritage were also more likely to not have screening.

Screening methods for colon cancer include stool tests, specialized X-rays, computed tomography (CT), and endoscopy tests such as sigmoidoscopy and colonoscopy. Only a colonoscopy offers the chance to see the entire length of the colon and to remove any polyps.

Men are less likely to be aware of the need for screening for cancer than are women. Men are more likely to go through with a colonoscopy than women are, but this only occurs when one is offered to them by their health care provider.

Further complicating the issue of early diagnosis is that men, in general, tend to be less aware of the symptoms of cancer. Studies show that men have more trouble recalling signs and symptoms related to their bowel and bladder habits. However, when men recognize that they are experiencing symptoms that require care, they are just as likely as women to seek it.

The number of men and women diagnosed at the more advanced stages of colon cancer is roughly similar. Young women tend to fare the best after a colon cancer diagnosis, and older women the worst.

However, men have a lower overall length of survival than women. It's thought that the many lifestyle and genetic factors affecting risk in men and the differences in hormones between the sexes may be some of the reasons for this effect.

A Word From Verywell

There are many identified risks of colon cancer. Some are tied to lifestyle, and others are factors beyond anyone's control, such as family history, sex, genetic conditions, and age.

A diet higher in red and processed meats, animal fats, and highly processed foods may contribute to an increase in risk. Smoking, excessive alcohol consumption, and low physical activity are also associated with higher rates of colon cancer.

While there is not robust data, it is thought that men, in general, may have more of these lifestyle factors that contribute to the development of colon cancer than do women. Even when these risk factors are not as prevalent, such as if a person makes changes to their diet and starts exercising, the need for screening is still important.

Colon cancer can also occur in people who have no identifiable or obvious risk factors. Colon cancer may be prevented with screening, because, when a polyp is removed, it does not have the chance to become cancerous. Colon cancer in its early stages is quite treatable, making early diagnosis critical to good outcomes.

Colon cancer tends to start at a younger age in men than it does in women. Changes to guidelines that call for screening tests in younger people may help address some of this issue.

However, there are other disparities, such as access to health care throughout one's lifetime as well as a colonoscopy when the time comes, that need to be addressed.

Black men, in particular, are at greater risk of both developing colon cancer and dying from it. There is a significant amount of research about colon cancer in general, but there is not enough when it comes to understanding how it affects minority groups, and men of ethnic minorities in particular. The reasons why younger people are being affected, and especially young men in minority groups, are still not well understood.

For these reasons, it's important that both men and women understand their individual risk of colon cancer by working with a health care provider. Further, we must call upon those who work in public health to include people of minority groups in their outreach and in further colorectal cancer research.

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