Movember for Men
There are no short cuts to improving your health and no magic bullets. Routine handfuls of vitamins will do you no good. In fact, randomised trials have repeatedly shown that people are actually worse off from popping vitamins.
Indeed, there’s no avoiding the fact that eating a wide variety of good food (lots of colours, more vegetables and fruit than dairy and meat) but not too much, keeping physically active, stopping smoking and making sure you don’t drink too much alcohol, are best. Boring, isn’t it?
Still, it’s the best way to avoid illness and disease. And of these, what scares people the most is cancer.
Two gentlemen in the waiting room of a practice I was working at were overheard by our reception staff chatting about a third, who had recently died.
“What did old Bill die of, then?” one asked. “I didn’t even know he was sick.”
“I don’t rightly know,” was the reply. “But I don’t think it was anything serious.”
Behind the apparent ludicrousness of this conversation is the implicit dread of cancer. Bill probably didn’t die of it. We would prefer to die of almost anything else.
The gender-specific cancer affecting women is breast cancer (although a very small number of men also get it). It runs neck and neck with lung cancer in causing more deaths and harm to women than any other. Luckily, we can do something about it because randomised trials have shown breast cancer can be detected by screening at the right age. And early detection and prompt treatment reduces the number of deaths from the disease.
But what about men? Is there something we can do to help them? The obvious contender is prostate cancer (women don’t have a prostate). It’s very common, it’s being diagnosed at increasingly greater rates, and causes a lot of early deaths (and harm).
So promoting screening for it is attractive. And it provides a nice symmetry. Women go off for their breast cancer screening at age 50, and their menfolk follow soon after. Of course, we know that men are much more reluctant to appear before the doctor, so we need something to encourage them. A sort of blokey message, “garn mate, y’know whatcha gotta do.”
Hence Movember. The trouble is we don’t know that screening for prostate cancer works.
That’s right. There’s huge controversy about it. There are advocates for screening (often those doctors who treat prostate cancer) and those who discourage it (especially public health and primary-care doctors).
The huge prostate cancer screening trials, equivalent to those of breast cancer from 20 or 30 years before, have only been published in the last year or two. And the results are ambiguous.
Some find a small benefit, and others none. It’s such a fine call that the evidence has done little to resolve the issue. Rather, experts are bunkering down to their prior beliefs, with each point of view finding some comfort in their interpretation of the trial data (which, it has to be admitted, is complicated and difficult to sort through).
All this means that one half of Movember, which aims to increase men’s awareness of prostate cancer and male mental health, is deeply flawed. Sadly, the campaign doesn’t focus on preventive activities we know to be particularly effective – stopping smoking, reducing alcohol consumption down from damaging levels, and doing more physical activity (although its website does mention them). Health promotion in this area is often unexciting and difficult, but we know it pays dividends in saved lives and avoided misery.
Instead, Movember focuses on something we are not certain is effective.
Worse than that, it might even be doing harm. Detecting cancer in men for whom treatment will confer no benefit is very damaging. Even the diagnosis is damaging. Men are nearly ten times more likely to commit suicide after being told they have prostate cancer.
And the treatment is damaging too. Despite real advances in the definitive treatment (“radical prostatectomy” – for which there are several methods), the chances are that most men will be rendered impotent by the operation, their penises will sink back, and the majority will develop urinary incontinence (temporarily for many – lasting for two years – but for some lasting well after even that).
All this is so counter-intuitive that it’s hard to explain. Surely, if you’ve got cancer, then treating it earlier must be better? Not necessarily. Only if we know that treatment is better than no treatment. And we don’t know that about prostate cancer.
If Movemeber focused more on the things that we know are effective, and steered off controversial areas which divide doctors, men would actually be much better off.