Most men need to pay more attention to their health, according to Frank dela Rama, RN, MS, AOCNS, a clinical nurse specialist in oncology/genomics at Palo Alto Medical Foundation in California.
Compared with women, men are more likely to smoke, drink alcohol in excess, make unhealthy or risky choices, and put off regular checkups and medical care, thereby increasing their risk for certain cancers. Many of the cancers that affect men are highly treatable, or even curable, if caught early enough. But despite this, they are often diagnosed too late due to the unwillingness of many men to pursue cancer screenings and regular medical checkups.
According to the Movember Foundation—the global charity that raises funds and awareness to stop men from dying too young—men often feel pressure to appear strong and stoic, and talking about feeling mentally or physically unwell can be perceived as weakness. By allowing those negative and harmful aspects of masculinity to be considered the norm, many men feel that’s the only way they can be considered “manly.”
At the AONN+ 9th Annual Navigation & Survivorship Conference, Mr dela Rama discussed men’s health issues in oncology and shared tips for oncology navigators working with male patients.
Cancers Specific to Men
On average, men die 6 years earlier than women across the world. The cancers that most often affect men are prostate, colon, lung, and skin cancers. Besides prostate cancer, other cancers that only affect men are testicular and penile cancers.
Testicular cancer is the most common cancer in young men aged 15 to 34 years, and 1 American man dies of it every day. Encourage patients to conduct testicular self-exams at least once a month, in the shower, while the testes are warm, Mr dela Rama advised. “It’s a cancer that we see men die of, but it’s very curable with current treatments.”
Prostate cancer is the second most common cancer in men in the United States. One in 8 men will be diagnosed with it in their lifetime, 3 million American men are currently living with it, and 73 men in the United States will die of prostate cancer every day.
The risk for getting prostate cancer increases as a man ages; most prostate cancers are found in men older than age 65 years. For reasons that are still unknown, African American men are more likely to develop prostate cancer than men of any other race, and having one or more close relatives with prostate cancer also increases a man’s risk.
Research has not yet proved that the benefits outweigh the harms of testing and treatment for prostate cancer, so the American Cancer Society (ACS) recommends that men 50 years or older (45 years or older for black men and men who had a father or brother diagnosed with prostate cancer before age 65) make an informed decision with their healthcare provider about whether to be tested.
If a patient does meet the necessary criteria for PSA screening, make sure he hasn’t had a rectal exam or any manipulation of the prostate within several weeks prior, as this could lead to an abnormally high PSA.
“Even though there are national guidelines, it’s really about individualized treatment and deciding if someone is appropriate for screening. There are marathon-running 75-year-olds and unhealthy 55-year-olds. It’s not necessarily about following concrete guidelines,” he said. “But prostate cancer is very curable, so we want to find it early.”
Colon, Lung, and Skin Cancers in Men
Men with a personal or family history of colon cancer; those who have polyps in their colon or rectum; those who are overweight, inactive, or smokers; and those with inflammatory bowel disease are more likely to have colon cancer. The ACS recommends that screening start at age 45 years, or earlier for those at higher risk. Colonoscopy is still the gold standard, but if a person chooses to be screened with an alternative test, any abnormal test result should be followed up with colonoscopy, he noted.
Lung cancer is one of the few cancers that can often be prevented simply by not smoking. Current or former smokers who are in fairly good health and between the ages of 55 and 74 years may benefit from screening for lung cancer with a yearly low-dose CT scan.
Most skin cancers can be prevented by limiting exposure to ultraviolet rays from the sun and other sources like tanning beds, but men, particularly those with a family history of melanoma, should be aware of all moles and spots on their skin and should report any changes to their healthcare provider immediately.
In patients who already have cancer, fertility can be a big concern no matter their age. When talking about the pros and cons of therapy with newly diagnosed men who want children, keep in mind that some treatments should be avoided. “If you have their proposed treatment regimen, you can advocate for them and discuss those fertility concerns with their doctor,” he said. “Some of these treatments have lifelong effects, but some don’t.”
Gay and Bisexual Men
Just as women’s health issues are different from those of men, gay and bisexual men have different health concerns as well. Fear of having a negative experience with a healthcare provider can lead some men to delay or avoid medical care, especially routine care such as early detection tests. Additionally, many health insurance policies do not cover unmarried partners, making it harder for many gay and bisexual men to get quality healthcare.
The ACS guidelines for gay and bisexual men contain more information about anal and testicular cancers, but it can be difficult to apply these guidelines. Men often don’t tell their providers about their sexual orientation because they worry about discrimination affecting the quality of the healthcare they receive.
Human papillomavirus (HPV) risk is increased by having anal sex, and HPV infection increases the risk for anal cancer. Smoking, having many sex partners, and having a weakened immune system because of HIV infection also increases the risk. A rectal exam will find some cases of anal cancer early, but some experts recommend screening with an anal pap test for those who may be at higher risk.
HPV vaccines can lower the risk for HPV infection and may also lower the risk for anal cancer in some men; these vaccines are recommended up to age 26 years for men who have sex with men.
“We should be talking to our patients and their partners,” Mr dela Rama said. “When you’re doing a risk assessment, these are things to think about in terms of anal cancer risk.”
So, Why Aren’t Men Going to the Doctor?
One theory is that men are not as enfranchised into the healthcare system as women. Women usually start receiving yearly pap smears and healthcare checkups at age 18 years, but men the same age may be falling off the radar.
Even when it comes to breaking the news of a cancer diagnosis, some studies have shown that men are more secretive than women and operate on more of a “need-to-know” basis. “My advice to navigators is to advise their patients not to tell their entire family all at once,” he said. “Once they have a treatment plan, that’s probably the best time for them to talk to their family.”
According to Mr dela Rama, no matter the reason, men should see a healthcare provider on a regular basis, learn about the benefits and limitations of testing for cancer early, and get the tests that are right for them.
