Influence of sex on the incidence of colorectal cancer: considering the influence of gender mechanisms (2025)

Résumé:

Context

Differences in colorectal cancer (CRC) incidence between men and women are documented, but the role
of gender mechanisms in explaining these disparities remains underexplored. CRC, the third deadliest cancer
worldwide, is often analyzed through “biological” sex differences, without a clear distinction between innate and
socially acquired factors. Gender mechanisms, including social roles, behaviors, and access to healthcare, may
significantly influence CRC risk.

Objective

This study quantifies the proportion of the effect of gender mechanisms on the relationship between sex
assigned at birth and CRC incidence, adopting a social epidemiology approach.

Method

Using data from the CONSTANCES cohort and the French National Health Insurance database (SNDS),
we identified relevant covariates with a Directed Acyclic Graph (DAG). Mediation analyses estimated the
contribution of socioeconomic, behavioral, anthropometric and medical factors as gender-related mechanisms.

Results

Men have a higher risk of CRC compared to women (OR: 1.54 [1.33; 1.79]). Men exhibit lower cultural
capital, higher social and economic capital, more frequent risk behaviors, and higher BMI. Gender mechanisms
account for 30 % of the association between sex assigned at birth and CRC incidence, in the imputed data, and up
to 50 % in the complete cases. Among the gender mechanisms, BMI emerged as the main mediator.

Conclusion

This study reveals that gender-based health inequalities in CRC incidence are partially explained by
differences in exposure to social and behavioral risk factors. These findings underscore the importance of integrating gender dynamics into public health strategies for CRC prevention and intervention, focusing on
addressing gender-based risk factor exposure.

Texte intégral:

A. Martinez, N. Hamieh, H. Colineaux, M. Kelly-Irving, P. Grosclaude, E. Wiernik, C. Delpierre, S. Lamy, Influence of sex on the incidence of colorectal cancer: considering the influence of gender mechanisms, Social Science & Medicine, Volume 376, 2025, 118058, ISSN 0277-9536, https://doi.org/10.1016/j.socscimed.2025.118058.