Men & Cancer Scotland Professor Alan White Centre for Men’s Health Leeds Metropolitan University

Comparison of the ratio of total deaths of men and women across the major disease classification groups, age brackets 1 to 24, 25 to 74 and 75+ years White, AK & Cash, K (2003) The state of men’s health across 17 European Countries. Brussels, The European Men’s Health Forum

Median rate ratio between men and women across 44 countries for mortality from all causes, by age White AK & Holmes M (2006) Patterns of morbidity across 44 Countries among men and women aged Journal of Men’s Health & Gender 3(2):

Death rates for Malignant Neoplasms, for men & women Adapted from White & Holmes (2006)

Patterns of mortality in men and women, years, UK, 2002 Calculated from White, AK, Holmes, M, (2006) Patterns of mortality across 44 Countries among men and women aged Journal of Men’s Health & Gender 3(2):

Patterns of mortality in men and women, 45-64years, UK, 2002 Calculated from WHOSIS Mortality Database MalesFemales

Proportion of cardiovascular disease, cancer and violence (injury and poisoning) within total causes of death; 3 years average ( ), EU 27 for Men Vitozzi, L (2009) The status of health in the European Union: towards a healthier Europe.

Arriaga decomposition of changes in life expectancies, EU15 average, Vitozzi, L (2009) The status of health in the European Union: towards a healthier Europe.

Contribution of change in mortality by circulatory diseases to changes in life expectancy at birth , selected countries, for men Change in life expectancy As a % of change in life expectancy Greece Spain2.467 France Italy Hungary154.5 Netherlands Austria2.439 Poland Portugal Romania Sweden United Kingdom Norway Vitozzi, L (2009) The status of health in the European Union: towards a healthier Europe.

Deaths due to selected cancers, for men and women, age years, Scotland, 2008 ISD Scotland (2009)

Calculated from Mortality statistics: cause. Review of the Registrar General on deaths by cause, sex and age, in England and Wales, 2003 Series DH2 no.30 ISD Scotland (2009)

Rate ratio of male to female cancer mortality, UK 2007 White, A, Thomson, C, Forman, D,(2009) The Excess burden of cancer in men, NCIN, London

Rate ratio of male to female cancer incidence, UK 2007 White, A, Thomson, C, Forman, D,(2009) The Excess burden of cancer in men, NCIN, London

ONS (2009) Cancer incidence and mortality in the United Kingdom and constituent countries, 2004–06

Scotland had the highest overall mortality rates for both males and females, at 17 per cent ONS (2009) Cancer incidence and mortality in the United Kingdom and constituent countries, 2004–06

In Scotland, the overall cancer mortality rates for both sexes were around 16 per cent higher than those for the UK as a whole, and the overall cancer incidence rates were 8 per cent higher. ONS (2009) Cancer incidence and mortality in the United Kingdom and constituent countries, 2004–06

The incidence of lung cancer was 34 per cent higher for males and 49 per cent higher for females than in the UK as a whole. The incidence of, and mortality from, other smoking-related cancers – oesophagus, lip, mouth and pharynx, and larynx – were also higher in Scotland than in the other countries of the UK. The incidence of prostate cancer was 14 per cent lower in Scotland than in the UK as a whole.

The mortality rate for lung cancer in Scotland was 34 per cent higher for males and 48 per cent higher for females than in the UK as a whole. In males it was nearly three times the mortality rate for prostate cancer and in females it was 56 per cent higher than the mortality rate for breast cancer. Male mortality from colorectal cancer was 38 per cent higher in Scotland than in the UK and female Mortality from cancer of the kidney and stomach was 29 and 35 per cent higher, respectively.

Factors involved in the development of cancer in men Lifestyle (Martin-Moreno et al. 2008, White 2009) Genetics (White 2009) Knowledge of genetic links within families (Moynihan & Huddart 2009) Reduced uptake of available screening (Brenner, H et al. 2007). Humoral and cellular immunity (Bouman et al. 2004) Help seeking behaviour (Smith et al 2005, Branney 2008) Knowledge of cancer (Macdonald et al. 2004) White, A, Thomson, C, Forman, D,(2009) The Excess burden of cancer in men, NCIN, London

Incidence and mortality rates by deprivation in Scotland Considering all cancers combined, the most deprived areas have incidence rates almost 40% higher than the least deprived areas; mortality rates for all cancers combined are approximately 75% higher in the most deprived than the least deprived areas.

Cancer age standardised incidence by deprivation quintile and sex; Northern & Yorkshire Forman, White & Farley (2006)

Cancer age standardised incidence by deprivation quintile and sex after excluding prostate and breast cancers; Northern & Yorkshire Forman, White & Farley (2006)

Cancer age standardised incidence by deprivation quintile and sex after excluding sex-specific, breast and lung cancers; Northern & Yorkshire Forman, White & Farley (2006)

The advantage of women in cancer survival: An analysis of EUROCARE-4 data Significant female advantages for head and neck, oesophagus, stomach, and pancreas, salivary glands, colon and rectum, lung, pleura, bone, melanoma of skin, kidney, brain, thyroid, Hodgkin’s disease and non-Hodgkin’s lymphoma. A significant female disadvantage for biliary tract, leukaemia and Bladder Michelia et al (2009) The advantage of women in cancer survival: An analysis of EUROCARE-4 data. European Journal of Cancer 45 ( 2009) 1017 –102

“Women had significantly higher survival than men for all cancers combined in each age class; however, this advantage reduced progressively with age: from +12.0% points at 15–44 years to +1.3% points at 75–99 years.” (p1022) Michelia et al (2009) The advantage of women in cancer survival: An analysis of EUROCARE-4 data. European Journal of Cancer 45 ( 2009) 1017 –102

Difference (%) between men and women in cancer survival across Europe Verdecchia et al (2007) Eurocare 4

Cancer World

Registrations of newly diagnosed cases of malignant neoplasm of colon & rectosigmoid junction & rectum, Scotland, by age and sex, ISD Scotland (2009)

Deaths registered as a result of malignant neoplasm of colon & rectosigmoid junction,& rectum by age and sex, 2008 for Scotland ISD Scotland (2009)

The case of Colo-rectal cancer 35% genetic factor –Hereditary non-polyposis colorectal cancer (3-5% of cancers, with many of these male) –1 st degree affected relative increases risk 2-4 fold –May include recessive genes, pathogenic mutations of low penetrance and complex gene- gene and gene-environment interactions Mitchell et al 2002 –Aggravated by mutations in APC, p53, k Ras and MSH2 genes (Fearon & Volgestein 1990)

Colo-rectal cancer risk increased by: –Diet low in fruit and vegetables –High intake of red and processed meat –Low physical activity –Alcohol –Smoking –Diabetes –Obesity

6.37 In 2006, a symposium organised by the Men’s Health Forum and chaired by the National Cancer Director discussed the issues around cancer and gender. The event highlighted that there are still many cancer types for which the reason for higher incidence and mortality in men is not known and that this higher incidence may be the result of unidentified risk factors or general biological predisposition. It is clear that more research is needed if we are to fully understand how gender impacts on cancer The Symposium also highlighted that the range of settings in which men are offered advice, information and routine health checks should be expanded from traditional primary and secondary care settings, for example into the workplace. CANCER REFORM STRATEGY 2007

The causes of these inequalities are not fully understood. Differences in lifestyle (e.g. smoking) and occupational exposure to risk factors are likely to be major factors. Report of the All Party Parliamentary Group on Cancer’s Inquiry into Inequalities in Cancer, 2009 (p10)

National Cancer Equalities Initiative A response to the Cancer Reform Strategy Gender visioning event in Leeds this year Report to be published in January 2010 Research and policy directives will emerge from this group

Conclusion Men are more at risk of developing and dying of those cancers that should affect men and women equally The reasons for men’s increased risk are many and are not just associated with higher smoking levels We need to be more proactive in reaching out to men to inform them of the risk and also what can be done about it. There is now recognition of this at Government and we will see progress…