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Men’s Health and the Excess Burden of Cancer in Men
Alan K. White a, Catherine S. Thomson b, David Forman c, Siegfried Meryn d,*
a
Centre for Men’s Health, Leeds Metropolitan University, Leeds, UK
b
Statistical Information Team, Cancer Research UK, London, UK
c
National Cancer Intelligence Network and Cancer Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
d
International Society for Men’s Health and Medical University of Vienna, Vienna, Austria
Article info
Abstract
Keywords:
Men
Gender
Help-seeking
Sex-associated Differences
Survival
Delay
Cancer
Context: Men seem to be at greater risk of both developing and dying from those
cancers that should affect men and women equally.
Objective: In this review, we argue for a more proactive approach to be adopted in
relation to men’s increased susceptibility to cancer.
Evidence acquisition: Cancer data from Cancer Research UK and the UK National
Cancer Intelligence Network were reviewed.
Evidence synthesis: In the United Kingdom, men have a 69% higher mortality rate
and a 62% higher incidence rate for the major cancers, which should affect men and
women equally. The rate of premature death is correspondingly high, with more
than 37 000 additional years of life presumably lost for working-age men (15–64 yr)
as a result of death from cancer. This pattern is repeated elsewhere but has received
little attention.
Conclusions: It is unclear why men are at greater risk, but a more proactive
approach should be taken to identify this issue as worthy of exploration and to
reach out to men at risk.
# 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
* Corresponding author.
E-mail address: [email protected] (S. Meryn).
1.
Introduction
Based on consideration of the current burden of cancer
among men estimated from the latest statistics in the
United Kingdom, the European Union, and the United
States, we argue that services should target men more
effectively. This argument is based on men’s increased
likelihood (1) of developing those cancers that should affect
men and women equally, (2) of having lower survival in
younger years compared with women, and (3) of having a
higher rate of premature death. This increased risk is
compounded by the possibility that men delay seeking both
preventive health care services and early appointments
following onset of symptoms. It is suggested that burden of
death from cancer would be reduced with heightened
surveillance and more rapid access to health care and
treatment.
2.
Cancer burden
For urologic cancers that are not sex specific, a gendered
dimension remains to the likelihood of developing the cancer
and of dying prematurely. A recent analysis in the United
Kingdom suggested that men have a nearly three-fold higher
rate of death from bladder cancer and twice as high a rate of
death from kidney cancer than women [1]. This trend extends
beyond the urologic cancers to the majority of cancers that
should affect men and women equally. The same study
highlighted that for all cancers except nonmelanoma skin
cancer, breast cancer, and the sex-specific cancers, men had a
69% higher rate of death and a 62% higher incidence rate
when considering all ages (Tables 1 and 2).
When considering the total cancer burden, men still
seem to have a disadvantage. In considering deaths in the
1569-9056/$ – see front matter # 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
doi:10.1016/j.eursup.2010.03.003
Please cite this article in press as: White AK, et al. Men’s Health and the Excess Burden of Cancer in Men. Eur Urol Suppl (2010),
doi:10.1016/j.eursup.2010.03.003
EURSUP-586; No. of Pages 4
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EUROPEAN UROLOGY SUPPLEMENTS XXX (2010) XXX–XXX
Table 1 – Rate* ratio of male to female cancer mortality, United Kingdom 2007
ICD-10 code
C00–C97
C00–C97
C00–C97
C00–C97
C15
C16
C18–C21
C22
C25
C33–C34
C43
C64–C66
C67
C70–C72
C82–C85
C90
C91–C95
excluding
excluding
excluding
excluding
Site description
C44
C44 and C33–C34
C44, C50, C51–C58, C60–C63
C44, C33–C34, C50, C51–C58, C60–C63
and C68
and C96
All cancers except NMSC
All cancers except NMSC and lung cancer
All cancers except NMSC, breast, and sex specific
All cancers except NMSC, breast, lung, and sex specific
Oesophagus
Stomach
Colorectum and anus
Liver
Pancreas
Lung
Malignant melanoma of skin
Kidney, other and unspecified urinary organs
Bladder
Brain and CNS
Non-Hodgkin’s lymphoma
Multiple myeloma
Leukaemia
Mortality rate ratios
All ages
15–64 yr
1.38
1.31
1.69
1.71
2.68
2.32
1.56
1.99
1.27
1.65
1.46
2.07
2.94
1.52
1.57
1.39
1.79
1.05
0.98
1.60
1.69
3.63
1.92
1.48
2.20
1.44
1.38
1.40
2.18
2.34
1.56
1.64
1.24
1.57
>65 yr
1.57
1.51
1.73
1.72
2.33
2.46
1.59
1.90
1.20
1.78
1.53
2.03
3.08
1.54
1.54
1.44
1.91
CNS = central nervous system; ICD = International Classification of Diseases [19]; NMSC = nonmelanoma skin cancer.
European age-standardised rates.
*
United Kingdom in 2007, cancer accounted for 29% of total
mortality for men compared to 25% in women; when
translated into age-standardized rates, the contrast is more
profound, with death rates of 211.3 males and 153.1
females per 100 000 cancer cases [1]. This pattern is
replicated elsewhere, with correspondingly higher rates for
men in the United States [2].
The effect of the increased cancer incidence and rate of
premature mortality can be seen clearly (Table 3) in the
mean age of death and the estimated years of life lost for
the working-age man (15–64 yr). The mean age of death
for the same group of cancers is approximately 3 yr earlier
for men in the United Kingdom, and an additional 37 000 yr
of life are presumably lost as a result of the higher rate of
premature death [3].
3.
Cancer survival
Cancer survival also has a gendered component. Micheli
et al found significant advantages for women in cancers of
the head and neck, oesophagus, stomach and pancreas,
salivary glands, colon and rectum, lung, pleura, bone, skin
(melanoma), kidney, brain, and thyroid as well as in
Hodgkin’s disease and non-Hodgkin’s lymphoma [4]. They
found significant advantages for men in cancers of the
biliary tract and bladder and in leukaemia, despite men’s
continued higher rate of premature death. Micheli et al
found that women in each age class had significantly higher
survival than men for all cancers combined; however, this
advantage reduced progressively with age, from +12.0%
points at 15–44 yr to +1.3% points at 75–99 yr.
Table 2 – Rate* ratio of male to female cancer incidence, United Kingdom 2007
ICD-10 code
C00–C97
C00–C97
C00–C97
C00–C97
C15
C16
C18–C21
C22
C25
C33–C34
C43
C64–C66
C67
C70–C72
C82–C85
C90
C91–C95
excluding
excluding
excluding
excluding
and C68
and C96
Site description
C44
C44 and C33–C34
C44, C50, C51–C58, C60–C63
C44, C33–C34, C50, C51–C58, C60–C63
All cancers except NMSC
All cancers except NMSC and lung cancer
All cancers except NMSC, breast, and sex specific
All cancers except NMSC, breast, lung, and sex specific
Oesophagus
Stomach
Colorectum and anus
Liver
Pancreas
Lung
Malignant melanoma of skin
Kidney, other and unspecified urinary organs
Bladder
Brain and CNS
Non-Hodgkin’s lymphoma
Multiple myeloma
Leukaemia
Incidence rate ratios
All ages
15–64 yr
1.16
1.10
1.62
1.61
2.48
2.48
1.54
2.21
1.27
1.64
0.92
1.99
3.30
1.53
1.39
1.52
1.72
0.80
0.76
1.44
1.45
3.01
2.44
1.40
2.35
1.38
1.37
0.76
2.01
2.75
1.58
1.36
1.54
1.56
>65 yr
1.57
1.53
1.77
1.77
2.22
2.50
1.62
2.18
1.21
1.80
1.42
2.05
3.54
1.52
1.40
1.52
1.99
CNS = central nervous system; ICD = International Classification of Diseases [19]; NMSC = nonmelanoma skin cancer.
European age-standardised rates.
*
Please cite this article in press as: White AK, et al. Men’s Health and the Excess Burden of Cancer in Men. Eur Urol Suppl (2010),
doi:10.1016/j.eursup.2010.03.003
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EUROPEAN UROLOGY SUPPLEMENTS XXX (2010) XXX–XXX
Table 3 – Years of life lost, England and Wales, 2007
ICD-10 code
C15
C16
C18–C21
C22
C25
C33–C34
C43
C64
C67
C71
C82–C85
C90
C91–C95
Site description
Oesophagus
Stomach
Colorectum and anus
Liver
Pancreas
Lung
Malignant melanoma of skin
Kidney
Bladder
Brain
Non-Hodgkin’s lymphoma
Multiple myeloma
Leukaemia
Mean age at death
Male
Female
71
74
73
71
71
73
66
71
77
61
71
74
71
77
77
77
74
75
74
69
73
80
63
75
76
74
Years lost (thousands) 15–64 yr
Male
Female
10
5
14
5
7
25
6
5
2
15
7
2
9
3
3
11
2
5
20
4
3
1
11
4
1
7
ICD = International Classification of Diseases [19].
It is possible to surmise that the cause of this increased risk
of developing and dying from these non–sex-specific cancers
is a combination of multiple factors, including lifestyle
(eg, smoking, alcohol, diet [5]), central obesity [6], germline
(impact of inherited and acquired genetic mutations [7,8]),
female biological advantage [9], and health behaviour factors
(eg, delay in presenting with symptoms) [10,11].
4.
Men and help seeking
The issue of help seeking is complex. Although there is
evidence that men delay for some conditions (eg, mental
health problems) [12], limited evidence shows this propensity with regard to cancer symptoms.
Macintyre and colleagues [13], in a review of the Scottish
Twenty-07 study, found no concrete evidence that men were
less willing to report health-related symptoms or to seek
health care, and there was no difference in the degree of
suffering that men experience prior to seeking help in
comparison to women. Reviewing the same data set, Wyke
and colleagues [14] presented the respondents with a
checklist of 33 symptoms of minor illness and asked if at
any time over the previous month the respondents had
experienced any of the symptoms and whether they had
consulted a general practitioner. The researchers found that
although women were more likely to have consulted a
general practitioner for at least one of the symptoms, there
was no difference in consultation rates when only those who
had reported symptoms within the last month were included
in the analysis, suggesting that men and women respond
similarly to the experience of symptoms. Adamson and
colleagues [15] found no significant difference between men
and women in the likelihood of either group seeking health
care advice based on socioeconomic and ethnic background.
A recent systematic review on delayed presentation and
referral of symptomatic cancer showed evidence that men
delayed seeking help with bladder cancer and other
urologic cancers but did not delay for digestive tract
cancers or lung cancer [16]. Few screening programmes are
aimed at both men and women, but bowel cancer screening
is an exception. Use of colorectal cancer screening has been
seen to be lower in men with regard to the faecal occult blood
test but higher in men for flexible sigmoidoscopy [17].
The data are still inconclusive as to whether men have a
significant disadvantage with regard to delaying help
seeking when they have cancer symptoms, but there is
evidence that men are not seeking preventive health care
appointments. In the United States, women are more likely
to receive preventive health care services from primary care
specialists than age-matched controls in men above the age
of 15 yr. The data include multiple visits for antenatal care
in the peak years of female fertility, between 15 and 44, but
even after these data are subtracted, the rate of visits for
preventive health care remains much higher for women
than for men (54.8 visits per 100 females per year
compared to 34.6 visits per 100 males per year) [18]. This
trend is compounded by the fact that a much larger
percentage of men has admitted to having no regular and
definable access to health care (21.8% of men compared to
11.6% of women).
5.
Conclusions
Men have an increased risk of developing and dying
prematurely from those cancers that should affect men
and women equally. It is not clear if men have a tendency to
delay seeking help compared with women. Studies should
be focused on why men are not exceeding women in their
medical consultations if they are at so much greater risk.
Absence of men from preventive health services and a lack
of recognition of the need to reach out to men to ensure that
cancers are either prevented or at least are picked up and
treated aggressively at the first opportunity should be the
absolute minimum requirement to try and reduce the
burden of cancer death in men.
Conflicts of interest
The authors have nothing to disclose.
Please cite this article in press as: White AK, et al. Men’s Health and the Excess Burden of Cancer in Men. Eur Urol Suppl (2010),
doi:10.1016/j.eursup.2010.03.003
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EUROPEAN UROLOGY SUPPLEMENTS XXX (2010) XXX–XXX
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among males from different Y-chromosome lineages. Prostate Cancer Prostatic Dis 2006;9:303–9.
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Please cite this article in press as: White AK, et al. Men’s Health and the Excess Burden of Cancer in Men. Eur Urol Suppl (2010),
doi:10.1016/j.eursup.2010.03.003