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18/03/2014

Cancer in men

Reducing incidence and mortality

Cancerinmen
Reducing incidenceandmortality

Cancerinmen:incidenceandmortality Whydomenhavehighercancerratesthanwomen? Howcanwereduceincidenceandmortalityinmen?

18/03/2014

Cancerinmen
Reducing incidenceandmortality

Cancerincidence C i id in i men: incidenceandmortality

ExcessCancerBurdeninMen. C.R.U.K.,2103

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ExcessCancerBurdeninMen. C.R.U.K.,2103

Cancermortalityrateratiosmen/women
3.50

3.00

2.89

2.89

2.50 2.21 2.01 2.00 1.65 1.50 1.70 1.58 1.53 1.92 1.62 1.42 1.27

1.54

1.00

0.50

ExcessCancerBurdeninMen.C.R.U.K.,2013

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Cancerinmen
Reducing incidenceandmortality

Maledeathsunder75 (allcauses)

Femaledeathsunder75 (allcauses)

26% 42%

ReducingprematuredeathsisanNHSOutcomesFrameworkindicator

Cancerincidencebysexanddeprivationindicator

OfficeforNationalStatistics:HealthStatisticsQuarterly

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Cancerinmen
Reducing incidenceandmortality

Why h d domenhave h highercancerratesthanwomen?

Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen?

Thecause(s)ofaround35%ofcancersthatoccur inthepopulationremainunidentified. Thisinevitablylimitsourunderstandingof genderdifferenceinincidencerates.

MenandCancer:SavingLives.MensHealthForum2013

18/03/2014

Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen? Biologicalexplanations
Therearenowellestablishedbiologicalexplanationsforhighercancerratesinmen. Therearesomehypothesesbutatthemoment,thesehavethepotentialonlytooffer marginalexplanations: Femalesexhormonesmaybeprotectiveagainstsomecancerstosomeextent W Women mayderive d i someprotection i from f their h i morevigorous i immune i systems Menmaybemoresusceptibletooxidativedamagetobodycells

Notethatsomebiologicalfactorspointtentativelytowardsthepossibilityofhigher cancerratesinwomen.
MenandCancer:SavingLives.MensHealthForum2013

Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen? Lifestylerelatedexplanations
Mostplausibleexplanationsofhighermaleratesofcancerarerelatedtogender differencesinlifestyles althoughthereisnodataquantifyingtheextenttowhich thesedifferencesexplaingenderdifferencesinincidence

Historically,menhavehadhighersmokingrates. Obesityratesareroughlyequalbetweenmenandwomen (around25%)butmenaremorelikelytobeoverweight(66%v 57%).Menarelessinterestedinlosingweight. Menhavepoorerdietsthanwomen,arelesswellinformed aboutnutrition.

18/03/2014

Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen? Lifestylerelatedexplanations
Menaremorelikelytodrinkalcoholtoexcess(38%v16%) Menaremorelikelytosufferworkrelatedexposureto carcinogens *** Menaremorephysicallyactivethanwomenbutbothsexes havelowratesofphysicalactivityoverall

Whydomenhavehighercancerratesthanwomen? Lifestylerelatedexplanations
Percentages of men and women exhibiting 2/3 or 3/3 risk behaviours, by social class (smoking, harmful levels of alcohol consumption, poor diet)

Dept.OfHealth.HealthSurveyforEngland2003

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Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen? Symptomawareness

CancerAwarenessMeasure.CancerResearchUK,2010

Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen? Useofservices
MenvisittheGPlessoftenthanwomen,evenaftercontrolling forreproductionrelatedconsultationsbywomen

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Domenconsultlessthanwomen?AnanalysisofroutinelycollectedUKgeneralpracticedata WangY,HuntK,NazarethI,FreemantleN,andPetersenI.BMJ,2013

Cancerinmen
Reducing incidenceandmortality

Oncediagnosed,menandwomenvisit theGPwithroughlyequalfrequency

18/03/2014

Cancerinmen
Reducing incidenceandmortality

Whydomenhavehighercancerratesthanwomen? Useofservices
Menarelesslikelytotakeuptheofferofscreeningforbowel cancer(56%v51%),eventhoughmenare60%morelikelyto developbowelcancer

Uptake by area-level deprivation gradient (grey dots represent individual postcode sectors stratified by age and gender) with separate regression lines for gender and age groups.

von Wagner C et al. Int. J. Epidemiol. 2011;ije.dyr008 Published by Oxford University Press on behalf of the International Epidemiological Association The Author 2011; all rights reserved.

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Cancerinmen
Reducing incidenceandmortality

Howcanwereduce d cancerincidenceinmen?

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Cancerinmen
Reducing incidenceandmortality

Howcanwereducecancerincidenceinmen? Developmalespecificinterventionstotacklethelink betweenbeingmaleandhavingapoorerlifestyle. Concentrateparticularlyonmenoflowereconomicstatus. Moreinterventionsindeprivedareasingeneralmight particularlybenefitmen. Developmalespecificsymptomawarenesscampaigns

Cancerinmen
Reducing incidenceandmortality

Howcanwereducecancerincidenceinmen? Tryoutsomeoftheapproachesthatwethinkmaybe effectivewithmen: Permissionorlegitimation Directiveinformation Workplace p basedinterventions Opportunisticinterventionsaimedatmen Phoneoremailconsultations Helpboystodevelophelpseekingskills

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Cancerinmen
Reducing incidenceandmortality

Howcanwereducecancerincidenceinmen? Weneedmoreandbetterresearch: Toreducethepercentageofcancersthatcurrentlyhave noknowncause and Toquantifytheproportionofthegenderdifferencethat cancurrentlybeexplainedbyknowncauses and Tobetterunderstandhowtodeveloppublichealth interventionsthatareeffectivewithmen.

Cancerinmen
Reducing incidenceandmortality

Howcanwereducecancerincidenceinmen? Challengetheimplementationofpolicy:e.g.equality legislation;OutcomesFrameworksindicators.

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18/03/2014

Cancerinmen
Reducing incidenceandmortality

Howcanwereducecancerincidenceinmen? Challengetheimplementationofpolicy:e.g.equality legislation;OutcomesFrameworksindicators.

Itwillbeimportanttomakesurethatthegender diff differences [i [inlif lifeexpectancy] ]do d notlead l dtoperverse incentivestofocusservicesmoreonmen.


FromtheEqualityAnalysis ofthePublicHealthOutcomesFramework

Cancerinmen
Reducing incidenceandmortality

david.wilkins@menshealthforum.org.uk

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