Proactive Screening for Men’s Health

Medical professionals have long known what statisticians and researchers have documented throughout the past half-century: Men and women face significantly different health challenges over the course of their lives.

Part of it is biology: prostate cancer vs. cervical cancer, for instance. Individuals can’t be killed by a body part they simply weren’t born with. But, a significant portion of the differences in how and when men and women die, and from what causes, is likely based on behavioral differences. For instance, the rates of mouth, throat and lung cancers for men are much higher than for women¹ — based mostly on the fact that men have, historically, been much more likely to smoke or chew tobacco than women. When more women took up smoking in the 1970s as the social taboo against women smoking abated, the difference in rates between men’s and women’s smoking-related cancers narrowed.² And, men remain almost twice as likely as women to die from accidental injuries, as well as from suicide.³ The former is likely due to more men holding dangerous jobs than women, while the latter is the subject of much study that has yet to yield any real insight.

How much behavioral differences that influence the mortality variance between men and women are based on socialization and how much on biology is probably a discussion for philosophers to have with psychiatrists. Still, beyond speculating on nature vs. nurture as to the root causes of the gender differential in morbidity, the fact remains that there is a wide gap between the sexes in cause and age of death. Overall today, cancer and morbidity rates are higher for men than for women throughout the developed world.⁴ Additionally, men are at higher risk than women for heart disease.²

Perhaps not surprising given the above statistics, women are also more likely than men to take advantage of preventive care. A pair of studies from the early 1980s illustrated that women invested significantly more than men in healthcare in both dollars and time. The first, an economic study conducted by Jody Sindelar, noted that since the advent of modern medicine in the early 20th century, women have been more likely to avail themselves of medical care. This is true across socioeconomic groups and all time periods studied, and this persists even after accounting for childbearing care that would obviously not affect men.⁵ The second, a medical study by L.M. Verbrugge, found that women are more likely to see a doctor for relatively mild symptoms, while men tend to wait until their condition is serious, even life-threatening.⁶

The Major Risks

Cancers and heart disease each account for roughly one-quarter of all deaths among men.³ Lung cancer remains the most deadly form, followed by cancers of the prostate, colorectal system and liver.⁷ Another 23 percent of all male deaths are classified as caused by “other” by the Centers for Disease Control and Prevention. Of the specified causes, accidental injury (including automotive crashes and workplace injuries) is the third-leading cause at 6.4 percent of all male deaths, followed by respiratory disease (5.5 percent), stroke (4.4 percent), diabetes (2.9 percent) and suicide (2.3 percent).

Cancer

Verbrugge’s observation about how men and women are raised and taught to react to physical ailment may be most applicable to cancer: “Males may be socialized to ignore physical discomforts; thus, they are unaware of symptoms that females feel keenly. Also, men may be less willing and able to seek medical care for perceived symptoms. When diagnosis and treatment are finally obtained, men’s conditions are probably more advanced and less amenable to control.”⁶

Verbrugge takes care to note that this is only a hypothesis on her part, yet it is consistent with all the data on the gender differential in mortality. Survival rates for most types of cancer in large part correspond to how early the disease is detected. The sooner treatment begins, the more likely the patient is to beat the disease. Women develop cancer at rates comparable to men, but because they seek care sooner, they die from it later in life. Men, on the other hand, delay seeking treatment longer than women do, as the Verbrugge and Sindelar studies indicate, so their cancers are further along when treatment begins.

In taking action to prevent cancer, however, there should not be any objective obstacles to male and female participation rates. Tobacco use among men has fallen by a third since the 1960s, and lung cancer rates have fallen along with it.⁸ Stopping smoking — and getting one’s family and friends to stop smoking to reduce exposure to second-hand smoke — remains the single-most effective strategy to reduce the odds of developing lung, mouth and throat cancers.

Other effective preventions for cancer include maintaining a healthy, nutritious diet, which also forestalls cardiovascular disease.⁹ A regular intake of fresh fruits and vegetables and limiting fat and cholesterol are now believed to help prevent the development of colorectal, esophageal, kidney and pancreatic cancers, and possibly prostate cancer —all of which are linked to clinical obesity.⁷

With advances in our understanding of colorectal cancer, along with improved detection and treatment, it is now recommended that everyone undergo regular screenings at age 50. Pre-cancerous polyps on the walls of the large intestine can be detected and removed before they metastasize. Screenings are the single most effective method for preventing the disease.¹⁰

Prostate cancer is not so easily prevented. It is apparently stimulated by the presence of male hormones. While early prostate cancer and pre-cancerous cells can be detected through simple blood tests (the prostate-specific antigen or PSA test), many men who survive the generally slow-growing prostate cancer will have significantly diminished quality of life. There is one promising class of drug, however, known as alpha-reductase inhibitors, that appears to lower a man’s risk of developing prostate cancer. Unfortunately, they carry the ominous side effect that if prostate cancer does arise during treatment, it will be a more serious and difficult type to treat. In addition, these inhibitors are associated with an increased risk of developing cardiovascular disease.¹¹ So, for now, there do not appear to be any effective methods of preventing prostate cancer — only regular screenings and treatment if the disease is found.

And, while the two most prevalent forms of skin cancer are also among the most common types of cancer that develop, carcinomas are easily treatable. Melanoma, conversely, is more dangerous and difficult to treat. However, like carcinomas, it can be prevented through the regular use of sunscreen. Regular examinations as part of an annual physical are recommended for those at risk of developing skin cancer.

Heart Disease and Stroke

Coronary and vascular disease progress far more slowly than do most cancers, with degradation measured in decades. But, the advancing of coronary or vascular disease, or increase in risk of a heart attack or stroke, is trackable from childhood on, with blood pressure readings and cholesterol levels fairly accurate gauges of risk.

Family history is perhaps the strongest indicator of risk for cardiovascular disease. The second strongest indicators are weight and fitness. The clinically obese are not only more prone to cancer, but are more likely to suffer a heart attack or stroke.¹² But, while diet and regular exercise are an important part of any cardiovascular disease prevention regimen, a physician’s review of a patient’s family history may also indicate the desirability of drug treatment.

Hypertension can be treated with a variety of classes of medications. In fact, most patients with high blood pressure can be prescribed a blood pressure control drug with acceptable side effects. High cholesterol also can be controlled with medication, often in conjunction with a blood pressure medication or blood thinners. And, of course, outpatient intervention to clear cholesterol-caused plaque from arteries is a last-resort tool available to prevent a heart attack.

While drugs may not address the root cause of high blood pressure or cholesterol, it is the blood pressure and cholesterol themselves that cause the systemic damage to the body. Therefore, relieving the symptoms is relieving the disease. Unfortunately, getting male patients to accept that they may need to take a maintenance prescription is — as the studies on male attitudes toward medical care show — perhaps the highest hurdle to treating their cardiovascular disease before it progresses.

Diabetes

Unlike with blood pressure and cholesterol, there is no prescription drug available to stop the advance of diabetes. The most effective method to prevent or at least delay the onset of type 2 diabetes is a combination of diet and exercise. The Mayo Clinic has a five-step program for those with a family history of diabetes,¹³ and it revolves wholly around physical activity and better eating. Exercise not only promotes weight loss, but also makes the body more sensitive to insulin. Fiber and whole grains also improve the body’s sugar control. The Mayo Clinic also recommends regular screenings for diabetes for patients 45 and older with a history of diabetes in the family.

Suicide

Suicide is perhaps the most troubling cause of early mortality for physicians — or society — to address. As Catholic theologian and philosopher Father Ron Rolheiser wrote in one of his many columns on the subject: “Suicide remains widely misunderstood and generally leaves those who are left behind with a particularly devastating kind of grief. Among all deaths, suicide perhaps weighs heaviest on those left behind.”¹⁴

While women remain more likely to attempt suicide, men are far more efficient at it.¹⁵ Decades of study on the gender differential in suicide rates have yielded dozens, maybe hundreds, of theories on the cause of this difference. Simultaneous medical research has found many promising treatments that have greatly helped untold numbers of patients — but almost no measurable impact on the overall rate of mortality, or on the ongoing gap between the numbers of men and women committing suicide.

Antidepressants have helped many patients. But, other patients have been found to react to some classes of these drugs by actually becoming more prone to suicide.¹⁶ Psychotherapy has also proven effective for patients suffering from some specific types of mental illness.¹⁷ Still, as the National Institutes of Health points out, there is no surefire way to prevent individuals from taking their own life. However, it’s noteworthy that most elderly victims of suicide met with their primary care physician within a year of their death, giving doctors a unique opportunity to offer preventive treatment.¹⁷

Improving Men’s Attitudes Toward Healthcare

Male attitudes toward their health differ significantly from those of women. The reasons are complex and, at this time, not well understood — although many researchers suspect that the roots of the issue lie in the fact that men are generally uncomfortable admitting weakness or asking for help. The many jokes about men being lost and unwilling to stop to ask for directions are, after all, based on many real-life experiences common to most families.

But, perhaps the military and professional sports offer a road map forward in getting men to move past their avoidance of seeking assistance. For instance, the National Football League (NFL), one of the most traditionally masculine of all sports, is currently struggling to address the prevalence of concussions and brain injury in its ranks. Football players — trained since childhood to “rub some dirt on it and get back in there” — are now working through their union to seek new rules that protect them and their place on the team (and, thus, paycheck) if they suffer a concussion in a game.

Another prime example is the United States Marine Corps, which prides itself on being the toughest of the tough. The Marine Corps now actively encourages its combat veterans to seek help if they show any symptoms of post-traumatic stress disorder (PTSD) when they return from the battlefield. Marines — as well as soldiers, sailors, airmen and Coast Guardsmen — are now able to receive confidential treatment for PTSD without worry about being branded a weakling or losing their next promotion.¹⁸

If Marines and NFL stars can be prodded to seek help without fear of being considered weak, there might yet be hope for physicians trying to get the rest of their male patients to get the preventive treatment they need to live longer, healthier lives.