Men & Cancer Scotland

Professor Alan WhiteCentre for Men’s Health

Leeds Metropolitan Universitya.white@leedsmet.ac.uk

www.leedsmet.ac.uk/health/menshealth

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

0.00.51.01.52.02.53.03.54.04.5

Men

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diso

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Ext

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Gen

itour

inar

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stem

Dig

estiv

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stem

Circ

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ory

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Res

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syst

em

Neo

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End

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Mus

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Rat

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25_74

75+

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 15-44. Journal of Men’s Health & Gender 3(2): 139-151

Age

75+65-74

55-64

45-54

35-44

25-34

15-24

5-141-4

5

4

3

2

1

0

Highest

Low est

Median

Death rates for Malignant Neoplasms, for men & women

Male

0

20

40

60

80

100

120

15 to 24 25 to 34 35 to 44

Ra

te p

er

10

0,0

00

Hungary 02

Thailand (00)

Romania 02

Armenia (02)

Portugal (02)

Latvia 02

Slovakia 00

Estonia 02

Lithuania 02

France 00

Hong Kong 00

Poland 02

Slovenia 02

Spain 01

Czech Rep

Denmark 99

Belgium 97

Argentina (01)

Greece 01

USA 00

Israel 99

Italy 01

New Zealand (00)

Brazil (00)

Chile

Australia (01)

Germany 01

UK 02

Netherlands 03

Austria 02

Canada 00

Norw ay (01)

Japan 02

Finland 02

Egypt 00

Sw eden 01

Female

0

20

40

60

80

100

120

15 to 24 25 to 34 35 to 44

Ra

te p

er

10

0,0

00

Hungary 02

Armenia (02)

Romania 02

Thailand (00)

Lithuania 02

Argentina (01)

Latvia 02

Slovakia 00

Denmark 99

New Zealand (00)

Poland 02

Portugal 02

Israel 99

Chile (01)

Belgium 97

Netherlands 03

Czech Rep 02

France 00

Brazil (00)

Estonia 02

UK 02

USA 00

Canada 00

Slovenia 02

Spain 01

Norw ay (01)

Italy 01

Australia (01)

Germany 01

Hong Kong 00

Austria

Greece 01

Japan 02

Finland 02

Sw eden 01

Egypt 00

Adapted from White & Holmes (2006)

Patterns of mortality in men and women, 15-44 years, UK, 2002

Males

0

5

10

15

20

25

30

35

40

45

15 to 24 25 to 34 35 to 44

Rat

e pe

r 10

0,00

0

Accidents and adverseeffects

Diseases of thecirculatory system

Malignant neoplasms

Suicide and self- inflictedinjury

Chronic liver disease andcirrhosis

Homicide and injurypurposely inflicted byother persons

Calculated from White, AK, Holmes, M, (2006) Patterns of mortality across 44 Countries among men and women aged 15-44. Journal of Men’s Health & Gender 3(2): 139-151

Females

0

5

10

15

20

25

30

35

40

45

15 to 24 25 to 34 35 to 44R

ate

per 1

00,0

00

Malignant neoplasms

Diseases of thecirculatory system

Accidents and adverseeffects

Suicide and self-inflicted injury

Chronic liver diseaseand cirrhosis

Homicide and injurypurposely inflicted byother persons

Patterns of mortality in men and women, 45-64years, UK, 2002

0

50

100

150

200

250

300

350

400

450

45 to 54 55 to 64

Rat

e pe

r 10

0,00

0

Malignant neoplasms

Diseases of the circulatorysystem

Chronic liver disease andcirrhosis

Accidents and adverseeffects

Suicide and self- inf lictedinjury

Homicide and injurypurposely inf licted by otherpersons

Calculated from WHOSIS Mortality Database

Males Females

0

50

100

150

200

250

300

350

400

450

45 to 54 55 to 64R

ate

per

100,

000

Malignant neoplasms

Diseases of the circulatorysystem

Chronic liver disease andcirrhosis

Accidents and adverseeffects

Suicide and self- inf lictedinjury

Homicide and injurypurposely inf licted by otherpersons

Proportion of cardiovascular disease, cancer and violence (injury and poisoning) within total causes of death; 3 years average (2001-

2003), EU 27 for Men

0%

20%

40%

60%

80%

100%

1-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

485

+

Age Group

Pro

po

rtio

n

Other diseases

Injury and poisoning

Cancers

Other forms of cardiovascular diseases

Cerebrovascular diseases

Ischaemic heart disease

Vitozzi, L (2009) The status of health in the European Union: towards a healthier Europe.

Arriaga decomposition of changes in life expectancies,

EU15 average, 1990-2000 0

1-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

5'-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

0

5

10

15

20

25

30

35

%

Men

Women

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 1980-

2000, selected countries, for men

Change in life expectancy

As a % of change in life expectancy

Greece 0.5 19.1

Spain 2.4 67

France 1.1 34.7

Italy 2.6 43.2

Hungary 1 54.5

Netherlands 1.9 63.3

Austria 2.4 39

Poland 1.6 133.1

Portugal 1.6 36.1

Romania 0.1 -9.8

Sweden 2.8 61.2

United Kingdom 2.5 60.2

Norway 2.5 68.3

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 15 - 64 years, Scotland, 2008

Malignant neoplasm of liver and intrahepatic bile ducts

0

20

40

60

80

100

120

140

160

180

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Oesophagus

-

10

20

30

40

50

60

70

80

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Stomach

-

5

10

15

20

25

30

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Colon & Rectrosigmoid junction

-

10

20

30

40

50

60

70

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

ISD Scotland (2009) http://www.isdscotland.org/isd/1508.html

Pancreas

-

5

10

15

20

25

30

35

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Bronchus & lung

-

50

100

150

200

250

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Brain

-

5

10

15

20

25

30

35

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Bladder

-

5

10

15

20

25

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

ISD Scotland (2009) http://www.isdscotland.org/isd/1508.html

Calculated from Mortality statistics: cause. Review of the Registrar General ondeaths by cause, sex and age, in England and Wales, 2003 Series DH2 no.30

Malignant melanoma

-

1

2

3

4

5

6

7

8

9

10

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female Kidney, except renal pelvis

-

5

10

15

20

25

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

Non-Hodgkins lymphoma

-

5

10

15

20

25

30

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

Male

Female

ISD Scotland (2009) http://www.isdscotland.org/isd/1508.html

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

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

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

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)

ASR by Deprivation Quintile - All Cancers, 2002-2004

0

50

100

150

200

250

300

350

400

450

500

Male Female

imd2004

AS

R

Q1

Q2

Q3

Q4

Q5

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)

ASR by Deprivation Quintile - All excl. prostate / breast, 2002-2004

0

50

100

150

200

250

300

350

400

450

500

Male Female

imd2004

AS

R

Q1

Q2

Q3

Q4

Q5

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)

ASR by Deprivation Quintile - All excl. sex specific & lung, 2002-2004

0

50

100

150

200

250

300

350

400

450

500

Male Female

imd2004

AS

R

Q1

Q2

Q3

Q4

Q5

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

02468

1012141618

Slove

nia

Mal

ta

Czech

Rep

ublic

The

Net

herla

nds

Italy

Polan

d

Spain

EUROCARE-4

mea

n

North

ern

Irelan

d

Ger

man

y

Belgiu

m

Englan

d

Scotla

nd

Switzer

land

Wales

Finlan

d

Norway

Icela

nd

Irelan

d

Austri

a

Sweden

%

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, 2008.

Colon, Rectosigmoid junction, Rectum

-

50

100

150

200

250

300

350

400

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Male

Female

ISD Scotland (2009) http://www.isdscotland.org/isd/1508.html

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

ISD Scotland (2009) http://www.isdscotland.org/isd/1508.html

Colon, Rectrosigmoid junction, Rectum

0

20

40

60

80

100

120

140

160

180

200

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Male

Female

The case of Colo-rectal cancer

• 35% genetic factor– Hereditary non-polyposis colorectal cancer (3-5%

of cancers, with many of these male)– 1st 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.6.38 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…