Article: Why are men so reluctant to seek medical help?

http://news.bbc.co.uk/2/hi/uk_news/magazine/8154200.stm

When doctors first examined former footballer John Hartson last week, he was already in the advanced stages of testicular cancer, which had spread to his brain and lungs. Why do men commonly get medical help later than women?

John Hartson went into Swansea's Singleton Hospital a week ago and doctors quickly established that he had testicular cancer which had spread to other parts of his body. Within days he'd had emergency brain surgery.

It's not clear whether the former Celtic and West Ham hero had ignored warning signs - sometimes testicular cancer has no symptoms.

Cycling legend Lance Armstrong, who has sent Hartson his best wishes, admitted he delayed going to a doctor for months before he was given a similar diagnosis in 1996.

A survey last month for the Everyman Male Cancer Campaign suggested that nearly twice as many men as women had not visited their GP in the past year.

Evidence suggests fewer men go to dentists or ask the pharmacist for advice and information, or attend contraception clinics, although men are more likely to end up in hospital because they delay for so long.

Even male cancer helplines are used more by women, speaking on behalf of partners, fathers or sons. And the fact that more women get skin cancer than men but more men die from it, indicates how late men are going to doctors.

Men are slowly getting better at it, says Mike Shallcross, associate editor of Men's Health magazine, but the contrast is made between men's attitude to testicular lumps and women checking their breasts for potential tumours.

"There's that fear when you find a lump on your testicle of thinking 'If I go to the doctor he'll just lop it off', which is the standard treatment, but you can get by perfectly with the one. But in the vast majority of cases, it's not cancer at all and you've done the right thing and got a weight off your mind."

This kind of comparison can be misleading, however, because women need to be more vigilant, he says, Breast cancer is much more common, with about 45,000 new cases a year compared with 2,000 new cases of testicular cancer, which makes up only 1-2% of male cancers and has a very high survival rate.

"Men could learn from women about attitudes to health. I would characterise it as the way they treat their cars. Women drive very carefully and make sure they take it into the garage at the right time but men just put their foot down until it's knackered."

Embarrassment and inexperience were the reason Martin Carter, 37, waited nine months to get his testicle checked after it became swollen and hard.

He finally got it seen when it swelled to four times its normal size and he had severe back pain and was losing weight. By then the cancer had spread to his lungs and abdomen and was pushing against his spine.

"I was only 20 and quite shy," he says. "Even though I was close to my family and friends, I just felt too embarrassed to tell anyone. I felt awkward.

"I thought it was something sexual, something I'd caught, and that made it even harder to talk about it. Back then testicular cancer wasn't so well known, there were no awareness campaigns like now.

"Also, I didn't know where to start. I was young and had hardly been to my doctor and when I had been, it was with a parent. That lack of experience meant I didn't know where to start when it came to seeing my GP."

Gender divide

He had his testicle removed, along with the tumours in his lungs and abdomen, and underwent chemotherapy. The treatment was successful but 14 years later, in 2006, his remaining testicle showed signs of cancer.

He got it checked straight away and was told the cancer had returned. But because he acted immediately it hadn't spread anywhere else and he only needed to have the testicle removed.

Martin's experience underlines the cultural reasons behind the gender divide in the self-diagnosis of cancer, says Professor Colin Cooper, head of the Everyman Centre, Europe's first research centre dedicated to male cancer.

"Historically women have always been the custodians of health in the family," he says. "They have cervical screening and breast screening and they take the kids to the GP. But men don't do any of that and tend to be much more reluctant to go when they have symptoms."

It could also be argued that women use the NHS at an earlier age, because of contraception or child birth, and they are generally more in tune with changes in their bodies.

Cancer survival rates in the UK are among the lowest in Europe because the British - both sexes - are for some reason less inclined to go to a doctor and cancer is diagnosed late, says the professor.

Celebrity Jade Goody, who died earlier this year after cervical cancer spread, ignored a letter saying a cervical smear test had indicated abnormalities. But generally women are better than men at acting.

"Men tend not to talk about health," he says. "Eight years ago we did a survey which found that men like to talk about sport, women, cars. Even politics is more popular than health issues. It has slightly opened up since but there's still a problem."

That's why men are going to doctors with very advanced cancer, he says, and John Hartson's survival prospects, although still quite good at about 60:40, would have been 99:1 had he been diagnosed earlier.

Men have a reluctance to ask for help or admit they have a problem about anything, says Peter Baker of Men's Health Forum, but basing primary health care around office opening hours hardly helps men who are in full-time work.

However, testicular cancer is not the major issue facing men because it's rare and the clear-up rate is high.

"Campaigns have worked because doctors are seeing testicular tumours at an earlier stage. If I was to pick one issue above all others, I would say obesity and we should do much more about alerting men to the dangers of being overweight."

Men are generally in poorer health, he says, with a worse diet. They are more likely to smoke and be alcoholics. They do more physical activity but the majority don't do enough to make any difference to their health.

"Taking risks and thinking nothing bad will happen is even seen as part and parcel of being a man," he says.

Health education should equip men with an understanding of what taking these risks means and how it affects their health, but it needs to be done in a humorous way to have any impact.

This should entail going to the workplace, the pub, the sports venues, and using humour to break down barriers, says Mr Baker.

A recent successful campaign was based on a Haynes car repair manual, with a man's body illustrated as a car engine.