Which cancers count? Men’s or women’s?

Submitted by Chris Hiley on Mon 1 Nov 10 - 13:34
in

Here’s a puzzle. Which is ‘worst’? Being a man with cancer or being a woman with cancer? It’s not a trick question, though I agree it looks like one. One gender does not get ‘easier’ cancers than the other.

Approximately equal number of men and women in the UK are landed with a cancer diagnosis each year– around 149,000 men and 149,000 women. Given the longer life expectancy for women – and that cancer is largely a disease of ageing - those crude numbers mask the counter intuitive fact that the rate of cancers in men is much higher. But that isn’t what I’m getting at. It’s not a population question I’m asking. It’s a question of perception, a social question about cancer in individual men and women. Which is worst? Which bother us more? A man with cancer, or a woman with cancer?

I ask because it’s evident that some rather wobbly social conventions have been imposed on the way cancer is portrayed and we buy into them quite unconsciously.  

I’m hoping that your gut reaction to the puzzle question is that each man with cancer and each woman with cancer is equally in the sh*t, or are at least teetering on the edge of it. I’m with you on that. You might distract yourself with the idea that some cancers are worse than others - certainly some are more aggressive, less treatable or more unpredictable than others - but I’m thinking more about the 'value' of the individual dragging a cancer diagnosis round with them, not about the ins and outs of their tumour's characteristics.
 
I think it's the person with cancer who counts. And it is also the count that counts i.e. how the numbers are presented.
 
Odd things begins to happen through the rhetoric of cancer numbers. This fuels the subliminal ‘This-cancer-is-worse-than-that-cancer’ posing that goes on within cancer campaigning groups. It is never stated out loud since it is not a winnable argument but much marshalling of resources goes into making that argument implicitly.
 
Both lung and colorectal cancer are also-rans in cancer coverage because they affect people not just men, or women. Men, or women, seem to matter more than ‘people’ when we’re presenting cancer. For some reason men and women disadvantage each other when they have the same cancer.
 
The messaging on lung and bowel cancer is considerably disadvantaged by not being able to use the sound bite resonance of ‘men only’ or ‘women only’ that the prostate and breast cancer lobbies can easily draw on.
 
The most common cancers from current UK incidence figures in people (descending order, rounded to the nearest 500) are:
  1. breast cancer 46,000 (women)
  2. lung cancer 39,000 (people)
  3. colorectal cancer 38,500 (people)  
  4. prostate cancer 36,000 (men)
Breast cancer will always be ahead in the ‘numbers diagnosed’ table. But prostate cancer advocates never say ‘Prostate cancer is the 4th most commonly diagnosed cancer in the UK’ which is plainly true. They say instead “Prostate cancer is the most commonly diagnosed cancer in men” which is also true.
 
Men diagnosed:
  1. Prostate cancer 36,000;
  2. Lung cancer 22,500;
  3. Colorectal cancer 21,000;
This also means lung and colorectal cancers both suddenly look less significant if the counts are separated into men and women. The numbers for women look like this.
 
Women diagnosed:
  1. Breast cancer 46,000;
  2. Lung cancer 17,000
  3. Colorectal cancer 17,500
But when it comes to deaths things shift around again. The most common cancers from current UK mortality figures (descending order, rounded to the nearest 500) are
  1. lung cancer 35,000 deaths (people);  
  2. colorectal cancer 16,500 deaths (people),
  3. breast cancer 12,000 deaths (women) and
  4. prostate cancer 10,000 (men)
Lung and colorectal kill most people but we prefer to separate out men and women
 
In women alone
  1. lung cancer 15,500 deaths
  2. breast cancer 12,000 deaths
  3. colorectal cancer 7,500 deaths,
In men alone
  1. lung cancer 20,000
  2. prostate 10,000
  3. colorectal 9,000
It’s all very muddling. I imagine you may have had a problem ploughing through all these numbers. No wonder the advocates pull out the ones that make their issues look largest, tout those and ignore the rest. I’d like to make the case with numbers that position people in their rightful place rather than preferring their genders. I fear both lung and colorectal cancers have lost their place in men’s and women’s cancer awareness.
 
For men and women the particular meaning of the gender specifics of prostate and breast cancer overshadows the significance of other cancers, particularly colorectal and lung.  
 
For me the most telling ranking is the one on numbers diagnosed. As before:
  1. breast cancer 46,000 (women);
  2. lung cancer 39,000 (people);
  3. colorectal cancer 38,500 (people) and 
  4. prostate cancer 36,000 (men)
If you are a cancer awareness sceptic who scoffs at the effect of health promotion in improving cancer outcomes consider the wider application of raising awareness of cancer – the awareness that influences research spend. Based on the list above you might imagine breast would be a bit out in front, with lung, colorectal and prostate in roughly equal parts fairly close behind. Not a bit of it. According to recent UK National Cancer Research Institute figures:
  1. breast cancer attracts about 20% of the ‘site specific’ research spend
  2. followed by colorectal cancer at 11%
  3. prostate cancer at 8%
  4. lung cancer at a derisory 3%.   
This suggests there is something very odd in the public ‘valuation’ of cancer and some of that oddness stems from muddle about cancer in men, women or people.