Background: Despite differences between men and women in incidence of colorectal cancer (CRC) and its precursors, screening programs consistently use the same strategy for both genders. Objective: The objective of this article is to illustrate the effects of gender-tailored screening, including the effects on miss rates of advanced neoplasia (AN). Methods: Participants (age 50–75 years) in a colonoscopy screening program were asked to complete a fecal immunochemical test (FIT) before colonoscopy. Positivity rates, sensitivity and specificity for detection of AN at multiple cut-offs were determined. Absolute numbers of detected and missed AN per 1000 screenees were calculated. Results: In total 1,256 individuals underwent FIT and colonoscopy, 51% male (median age 61 years; IQR 56–66) and 49% female (median age 60 years; IQR 55–65). At all cut-offs men had higher positivity rates than women, ranging from 3.8% to 10.8% versus 3.2% to 4.8%. Sensitivity for AN was higher in men than women; 40%–25% and 35%–22%, respectively. More AN were found and missed in absolute numbers in men at all cut-offs. Conclusion: More AN were both detected and missed in men compared to women at all cut-offs. Gender-tailored cut-offs could either level sensitivity in men and women (i.e., lower cut-off in women) or level the amount of missed lesions (i.e., lower cut-off in men).

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Keywords Colorectal cancer, fecal immunochemical test, gender, miss rates, screening
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Journal United European Gastroenterology Journal
Grobbee, E.J. (Esmée J), Wieten, E, Hansen, B.E, Stoop, E, de Wijkerslooth, T.R, Lansdorp-Vogelaar, I, … Spaander, M.C.W. (2017). Fecal immunochemical test-based colorectal cancer screening: The gender dilemma. United European Gastroenterology Journal, 5(3), 448–454. doi:10.1177/2050640616659998