Background Consultation rates with general practitioners (GPs) are higher in women than in men from late childhood through middle age, though not in childhood and later life. This gender patterning, and qualitative data documenting men’s apparent reluctance to consult, has fuelled widespread assumptions that men are always more reluctant to consult and this may partly explain gender differences in longevity (delayed consultation leading to later diagnosis and decreased opportunities for treatment in men). However, few studies have critically examined this assumption or compared consultation patterns in men and women with similar morbidity. Here we use UK general practice data to examine whether there are gender differences in incidence, survival and consultation patterns prior to diagnosis in patients with three common non-sex-specific cancers: lung, colo-rectal (CRC) and melanoma.
Methods We used data from the Health Improvement Network (THIN) database to identify cohorts diagnosed between 1997–2006 with lung cancer (LC) (n = 9,872), CRC (n = 7,075) and melanoma (n = 1,429). Sex-specific annual incidence rates, cumulative probability of survival to 5 years and consultation patterns in the 12 months preceding diagnosis were compared.
Results In 5,041 men and 3,292 women who died within 5 years following a LC diagnosis, average survival time was 7.9 months. There was little difference in survival between men and women (HR 0.946, p=0.046); the small survival advantage was in men. On average people diagnosed with LC had 10 consultations in the year prior to diagnosis (men 10.1 [95% CI 10.05, 12.21], women 11.0 [10.87, 11.07]). There were no gender differences in consultation rates in any month in the year preceding diagnosis. 2,903 men and 2,291 women died within 5 years following a CRC diagnosis. Average survival time in months differed little by gender (17.6 (men) and 15.4 (women)). Consultation patterns were again similar in the year prior to diagnosis (men 8.99 [8.89, 9.09], women 9.43 [9.32, 9,54]), and did not differ by gender in any month in that year. Similar results are presented for melanoma.
Conclusion If gender differences in propensity to consult (reluctance amongst men, leading to later diagnosis) were to make a substantial impact on gender differences in mortality, we would expect large gender differences in survival and/or in consultation patterns prior to diagnosis in the most common cancers. This analysis provides strong evidence against this explanation for gender differences in health, and suggests the need for a more critical view of gender and consultation.
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