Monday 26 September 2016

'Men ignore illness. We pretend it's not there'

Women are far quicker to access healthcare, but early intervention is vital in cancer

Published 16/09/2015 | 02:30

Living with cancer: Prof John Monaghan. Photo: Gerry Mooney.
Living with cancer: Prof John Monaghan. Photo: Gerry Mooney.

It is common knowledge that men are more reluctant to seek medical advice than women. Men soldier on, well, manfully. They ignore symptoms, scorn regular check-ups and hurriedly switch channels whenever the words "testicular" or "prostate" are mentioned.

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This is somehow conventional wisdom, connected to an idea of manhood that has to do with stoicism and machismo. But is it true?

A study in the Journal of Health Services Research and Policy found that, when it came to headaches and back pain, there was "patchy" evidence to support the claim that women see the doctor more than men.

But other research, carried out for the Everyman Male Cancer Campaign in the UK confirms the idea of male reluctance to confront medical bad news. Twice as many women as men have visited their GP in the last year.

Men are less likely to ask a pharmacist for advice than women, and less likely to visit the dentist, but more likely to end up in hospital because they delay for so long. Even male cancer helplines in the UK get more calls from women than from men.

When it comes to accessing healthcare, there is no difference between the sexes up to age five. After that, males lag behind females all the way up to age 75, when men take over, possibly because of the chronic conditions they ignored in earlier years.

There have been some high-profile cases of men delaying the inevitable. Disgraced cyclist Lance Armstrong admitted he delayed seeing a doctor for months before being diagnosed with testicular cancer.

And John Hartson, a professional footballer with Celtic, West Brom and Norwich City, delayed seeing his doctor for so long that his testicular cancer had spread to his brain and lungs.

"There is no doubt that men are at greater risk of getting cancer than women and have a lower survival rate when they do," says Kevin O'Hagan, cancer prevention manager with the Irish Cancer Society.

"And that's not just for the male-specific cancers such as prostate and testicular cancer. The incidence of bowel cancer and melanoma is also higher among men."

According to the 2013 'Report on the Excess Burden of Cancer Among Men', by 2035, male cancer will increase by 213pc on 2005 levels, or 7pc per year. Cancer among women will increase by 165pc, or 6pc per year.

Men across Europe are more likely to get every kind of cancer than women are (except, of course, breast and cervical cancers). The incidence of bladder, lung, colorectal cancer and melanoma is higher among men, and that's without taking into account the men-only cancers of the prostate gland and testicles.

Genetic and lifestyle factors are important: some 29-38pc of all cancers are due to smoking, and up to 10pc to excess drinking, and men do more of both than women. But men's reluctance to engage with health services is also an issue.

"It's seen as part of what it means to be a man: don't be weak, don't be vulnerable," says Kevin O'Hagan. "Men are designed to be tough and hard and unbreakable. Some find it embarrassing or difficult to come out and say 'I have a problem'."

"Women are much better," says cancer patient Prof John Monaghan, who is involved with the cancer support group Men Against Cancer.

"If they have an issue with their health, they will see their doctor or they will talk to their friends. Men, well, we'll ignore this and shut up and pretend it's not there."

The readiness of women to seek help, and the reluctance of men, is evident in calls to the Irish Cancer Society's helplines. "It's 70pc women and 30pc men," says Kevin O'Hagan. "And we have many instances of wives or partners calling on behalf of men, and even putting them on the line once the call is made."

Men are even shy about seeking support once a diagnosis is made, according to Deirdre Grant, CEO of the Arc cancer support centres.

"The first thing I'd say is that men come less to the centre than women do. Women generally are better at seeking support. It's quite hard to get men through the door," says Deirdre.

"We see 1,800 people in our centres, and six visits per patient is the average, so we're quite busy. But only 25pc of our visitors are men. Anecdotally, among men, we see mostly colon, prostate and lung cancer."

Often women have had experience of the health system relating to contraception or childbirth and are relatively comfortable accessing services. Despite the gender imbalance at consultant level, the health service "is a predominantly female environment, and some men are not comfortable with that," points out Kevin O'Hagan.

The statistics on men's cancers make for grim reading. Some 60 men per 100,000 of the population are diagnosed with lung cancer every year, compared to 40 women. Nearly 48 men per 100,000 die of this cancer every year, while 28 women men do.

Colorectal cancer affects 41 per 100,000 women, but over 65 men, with nearly 14 deaths per 100,000 for women as against nearly 26 deaths for men.

There are 3,384 new cases of prostate cancer diagnosed every year, which is 157 cases per 100,000 men. Some 519 men die from this disease every year, accounting for 11pc of all cancer deaths.

"In many, many cases prostate cancer is a slow-growing cancer," says Prof Monaghan. "Many men in their mid-70s and 80s probably have prostate cancer but it will be very slow-growing, it will be contained in the prostate sac and they will die of something else."

Testicular cancer has a completely different profile, affecting mostly younger men. Of the 132 cases diagnosed per year in Ireland, over three-quarters were for men under 40. However, this type of cancer is very treatable, with a five-year survival rate of well over 90pc.

The success of treatment often comes down to early detection, which in turn comes down to a readiness to seek help and access the services available. The undue incidence of cancer in men is not about a men vs women battle of the sexes. It's about men seeking help earlier.

"We need men to be aware that there is help there. We need role models, such as former Ireland rugby star Tony Ward, who spoke about having prostate cancer," says the Irish Cancer Society's Kevin O'Hagan.

The Society has tried everything, including using humour to tackle the distinctly unfunny topic of cancer. They even used Podge and Rodge in a bowel cancer campaign.

"Men need the information tailored for them, in a way they feel comfortable accessing. It needs to be framed in a man-friendly way, and it needs to be there in setting where men congregate, whether that's at sports events or agricultural shows or whatever," he adds.

The National Men's Health Policy from the Department of Health attempts to set out a constructive approach, based not on criticising men for their reluctance to seek help, but to support them in doing so, and based not on pitting them against women in a "cancer war" but on encouraging them simply to care more about themselves.

Arc runs cancer support centres in Dublin. Mater Hospital, tel 01 8307333, and St James's Hospital, at tel 01 7078880. They are running workshops about how to talk to children about cancer on September 21 in their Eccles Street centre, and a course for carers of cancer patients in both centres on October 7. For more details see arccancersupport.ie.

'You can either consider yourself to be dying of cancer, or living with cancer. I'm living with cancer'

Professor John Monaghan (71) was diagnosed with prostate cancer in 2011. He still has cancer, "but they are cancer cells rather than tumours".

"I started to take flying lessons back in 2010 when I was 66. Every year you have to go for a medical, so in March 2011 I went for the flight medical to be told that my PSA [prostate-specific antigen] had been considerably elevated from results I had about four months earlier.

"In June 2011, I went to see a consultant. Biopsies were done in June and it was confirmed that I had prostate cancer. The feeling was that it was pretty severe, but that it was contained within the prostate gland and the recommendation was surgery.

"I had robotic surgery for the removal of the prostate, and it went really well. I was out of hospital within three days. The difficulty was, by the time they had opened me up to take out the prostate, they discovered that the cancer was more severe than they anticipated.

"Unfortunately, because of trying to clear away that size of tumour and the surrounding area, I was left incontinent.

"Nonetheless, I was out of hospital within three days. The surgery was in August 2011, and by September I was teaching, and by the middle of October I was flying again.

"It was soon obvious that they needed more surgery to correct the incontinence, and secondly, the cancer started to come back. They had to monitor the cell activity throughout the remaining months of 2012, and in October I had more surgery for the fitting of an artificial male sphincter, which controls the incontinence.

"In the early part of 2013 around April it was decided I needed what they call salvage radio therapy so, I started seven weeks of external electron beam radiotherapy. It's like a shotgun. They're trying to kill off cells in the area where the prostate was. And that was fine.

"I mean, I coped with the radiotherapy fairly well. Unfortunately, the artificial male sphincter device started to malfunction, so I was back incontinent again.

"That happened in the summer of 2013. Again, it was obvious that the PSA was starting to rise again.

"Issues that had to be addressed: the defective sphincter, which needed more surgery, and then watching the PSA. That got us to the middle of 2014 when I started on hormone therapy.

"These are injections that I take every three months to start the production of testosterone because it acts as a fuel for cancer cells. And that's been working very effectively. There was a bit of a scare when I picked up pneumonia on a flight to Australia and it seems to upset things, and the cells seemed not to be reacting to the injections but that has calmed down now and I'm on hormone therapy; I'm continuing to do all the things I've done.

"The cancer didn't stop me doing anything at any time: I continued working, I continued driving, continued flying, continued my involvement with the Society of St Vincent de Paul, where I was national vice president up to recently, continued to do a bit of wood-turning down in the shed.

"I didn't have any symptoms whatsoever. I had no pain, I wasn't finding it difficult to pass urine, so there were no effects whatsoever. Indeed were it not for the fact that I was taking flying lessons, I probably would be dead by now.

"My attitude in all of this is, you can either consider yourself to be dying of cancer, or living with cancer. And my attitude from the very beginning was, okay, I am living with cancer.

"I have cancer now, but I'm living with it. I wasn't going to just curl up in a ball and die."

Irish Independent

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