Blog written by:
Professor Sara Faithfull
Chair NCRI Living With and Beyond Cancer, Late Consequences Workstream
University of Surrey
November is men’s health awareness month and I use this blog as an opportunity to consider why there have been reductions is male cancer diagnosis? The mayhem caused by the COVID-19 pandemic has produced trends in cancer registrations that are worrying, this is the case across many countries. In England alone there were 52,000 fewer people referred for prostate cancer screening than the year before and as a result 8,600 fewer men are receiving treatment for prostate cancer (NCRAS 2021). In Italy cancer diagnosis in 2020 fell by 39% compared to average years with men with prostate cancer 75% lower than in 2018-19 (De Vincentiis 2021). The key question is how do we find the missing men, and does it matter?
Symptoms for prostate cancer are subtle, changes in urinary flow, getting up at night more often to pass urine and can be put down to age. Early prostate cancer may show no symptoms, but risk factors can be clues for encouraging screening: (i) prostate cancer mainly affects men over 50 (1 in 8), (ii) risk increases with age, (iii) higher if there is a family history of prostate cancer and (iv) for black men prostate cancer prevalence is much higher (1 in 4) and occurs from age 45. For family nurses November may be an opportunity to check prostate cancer risk in your older male patients, ask about changes in urinary function as men can be embarrassed to discuss urinary problems and think about their prostate cancer risk profile. A risk checker is available from PCUK for men to explore what their personal risk is and information on what to do if risk is high (Prostate Cancer UK online risk checker 2021).
During the pandemic people were nervous about safety, not wanting to put additional strain on health services but this is not just now. Men are known to be reluctant to seek healthcare and a large survey in the USA at the Cleveland Clinic found that only 7% of men discussed their health with peers and 42% would consult a healthcare practitioner over a worrying symptom (MENtion it 2019) so work is needed to remove barriers and make healthcare more male accessible.
What will be the impact for these missing men if we can’t find them soon? The pandemic has had an impact across many chronic conditions where diagnosis and treatment may have been delayed but a late diagnosis for men with high-risk prostate cancer may mean the difference between a curative localised cancer and systemic advanced disease. It may be many years for us to know the true impact of these late diagnosis on men’s quality of life and mortality.
Let’s make November an opportunity in family nursing practice to think could your men be at risk of prostate cancer and see if we can reduce the number of missing?
NCRAS (2021) https://www.gov.uk/guidance/national-cancer-registration-and-analysis-service-ncras
De Vincentiis L, Carr RA, Mariani MP and Ferrara G (2021) Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018-19: an audit from cellular pathology J Clin Pathol 74: 187-189
Prostate Cancer UK (2021) prostatecanceruk.org/riskcheck #MenWeAreWithYou.
MENtion It (2019) Cleveland Clinic https://newsroom.clevelandclinic.org/2019/09/04/cleveland-clinic-survey-men-will-do-almost-anything-to-avoid-going-to-the-doctor/ accessed October 2021