The state of men's health - Nordic conference-printable · Journal of Men’s Health & Gender 3(2):...

The State of Men’s Health –a Nordic perspective

Professor Alan White

Centre for Men’s Health Leeds Metropolitan UniversityEuropean Men’s Health Forum

[email protected]/health/menshealth

Median rate ratio, male/female, 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

5-14

1-4

5

4

3

2

1

0

Highest

Low est

Median

Rate ratio, male/female, of mortality for all causes

of death

Finland (02)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1 to 4 5 to 14 15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Denmark (99)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1 to 4 5 to 14 15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Norway (01)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1 to 4 5 to 14 15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Calculated from WHOSIS 2005

Sweden (01)

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1 to 4 5 to 14 15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Analysis of the rate ratio, male/female, mortality for

selected cancers across 14 countries (latest year)

• Countries:

• Argentina (2001)• Australia (2001)• Austria (2002)• Brazil (2000)• Denmark (1999)• Estonia (2002)• Hungary (2002)• Japan (2002)• Portugal (2002)• Spain (2001)• Sweden (2001)• Thailand (2000)• UK (2002)• USA (2000)

White, AK (in press) Men and Cancer. In Kirby, R, Carson, C,

White AK, Kirby, M (Eds) Men’s Health 3rd Ed Informa Healthcare, London

The median rate ratio, male/female, for cancer mortality for 14 countries, for all malignant neoplasms

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75+

High

Low

Median

The median rate ratio, male/female, for cancer mortality for 14 countries, for all malignant

neoplasms, excluding breast and the principal sex specific cancers*

* cervix uteri, uterus, and prostate

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75+

High

Low

Median

Rate ratio, male/female, for all malignant neoplasm

and the all malignant neoplasms excluding breast and

sex specific cancers.

Denmark (1999)

0

0.5

1

1.5

2

15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Rate ratio m

ale/female

All malignant neoplasms


excluding breast and sex

specific


Norway (01)

0

0.5

1

1.5

2

15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Rate ratio M

/F




specific


Finland (2002)

0

0.5

1

1.5

2

2.5

All Age

s15

to 2

425

to 3

435

to 4

445

to 5

455

to 6

465

to 7

4

75+

Rate ratio M

/F




specific

UK (2002)

0

0.5

1

1.5

2

15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Rate ratio m

ale/female




specificSweden (2001)

0

0.5

1

1.5

2

15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Rate ratio m

ale/female




specific

Prostate cancer, rate per 100,000, within

Nordic countries and the UK


0

100

200

300

400

500

600

700

15 to

24

25 to

34

35 to

44

45 to

54

55 to

64

65 to

74

75+

Rate per 100,000

Denmark (1999)

Finland (2002)

Norway (2001)

Sweden (2001)

UK (2002)

Rate ratio, male/female, mortality for selected cancers, UK, 2002

Calculated from

WHOSIS 2005

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Lip

ora

l cav

ity a

nd pha

rynx

Oes

opha

gus

Sto

mac

hCol

on

Rec

tum

rec

tosigm

oid ju

nctio

n an

d an

us

Live

rLa

rynx

Trac

hea b

ronc

hus an

d lung

Bladd

erOth

er site

sLe

ukae

mia

Rate ratio M

/F

45 to 54

75+

Rate ratio, male/female, mortality for selected

cancers, Denmark, 1999

Calculated from

WHOSIS 2005

0.00

1.00

2.00

3.00

4.00

5.00

Lip

ora

l cav

ity a

nd p

hary

nxO

esop

hagu

sSt

omac

hCol

on

Rec

tum

rec

tosigm

oid

junc

tion

and

anus

Live

rLa

rynx

Trac

hea

bro

nchu

s an

d lu

ngBl

adde

rO

ther

site

sLe

ukae

mia

Rate ratio M/F

45 to 54

75+


cancers, Finland, 2002

Calculated from

WHOSIS 20050.001.002.003.004.005.006.007.008.009.0010.0011.0012.0013.0014.0015.0016.0017.0018.0019.00

Lip ora

l cav

ity a

nd pha

rynx

Oes

ophag

us

Sto

mac

h

Colon

Rec

tum r

ecto

sigm

oid ju

nctio

n and

anu

s

Live

r

Larynx

Tra

chea

bronc

hus an

d lung

Bladd

erOther

site

sLe

ukae

mia

Rate ratio M/F

45 to 54

75+


cancers, Norway, 2001

Calculated from

WHOSIS 2005

0.00

1.00

2.00

3.00

4.00

5.00

6.00

Lip

ora

l cav

ity a

nd p

hary

nxO

esop

hagu

sSt

omac

h

Col

on

Rec

tum

rec

tosigm

oid

junc

tion

and

anus

Live

rLa

rynx

Trac

hea

bro

nchu

s an

d lu

ngBl

adde

rO

ther

site

sLe

ukae

mia

Rate ratio M

/F

45 to 54

75+


cancers, Sweden, 2001

Calculated from

WHOSIS 20050.001.002.003.004.005.006.007.008.009.0010.0011.0012.0013.0014.0015.00

Lip

ora

l cav

ity a

nd p

hary

nxO

esop

hagu

sSt

omac

h

Col

on

Rec

tum

rec

tosigm

oid

junc

tion

and

anus

Live

rLa

rynx

Trac

hea

bro

nchu

s an

d lu

ngBl

adde

rO

ther

site

sLe

ukae

mia

Rate ratio M

/F

45 to 54

75+

Malignant neoplasm’s as proportion of total deaths in men, 15-64 year age bracket


0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

Denmark

(1999)

Finland

(2002)

Iceland

(2001)

Norway

(2001)

Sweden

(2001)

UK (2002)

Percentage (%)

0.001.002.003.004.005.006.007.008.009.0010.0011.0012.0013.0014.0015.0016.0017.00

Oes

opha

gus

Sto

mac

h

Bow

el

Live

rPan

crea

s

Lung

Melan

oma of

skin

Kidne

y et

c.

Bladd

er

Non

-Hod

gkin ly

mph

oma

Rate ratio M

/F

Finland

Denmark

Estonia

Norway

Scotland

Sweden

Rate ratio, male/female, cancer registrations for selected countries, age 15-64 years

D.M. Parkin, S. Whelan, J. Ferlay and H. Storm. Cancer Incidence in

Five Continents, Vol. I to VIII.IARC CancerBase No. 7, Lyon, 2005.

Rate ratio, male/female, cancer registrations for selected countries, age 65+ years

D.M. Parkin, S. Whelan, J. Ferlay and H. Storm. Cancer Incidence in

Five Continents, Vol. I to VIII.IARC CancerBase No. 7, Lyon, 2005.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

All site

sOes

opha

gus

Sto

mac

h

Bow

el

Live

rPan

crea

s

Lung

Melan

oma of

skin

Kidne

y et

c.

Bladd

er

Non

-Hod

gkin ly

mph

oma

Rate ratio M

/F

Finland

Denmark

Estonia

Norway

Sweden

Scotland

Difference (%) between men and women in cancer survival across Europe

Verdecchia et al (2007) Eurocare 4

024681012141618

Slov

enia

Mal

ta

Cze

ch R

epub

lic

The

Net

herla

nds Ita

lyPo

land

Spai

n EUR

OCAR

E-4

mea

n

Nor

ther

n Ire

land

Ger

man

yBe

lgiu

m

Engl

and

Scot

land

Switz

erla

nd

Wal

es

Finl

and

Nor

way

Ic

elan

d Ire

land

Au

stria

Sw

eden

%

Causes of men’s higher risk of cancer

• Germline

• Somatic

• Men’s help seeking behaviour

Germline

• The lifetime breast cancer risk for men with BRCA2 mutations is about 7% (American Cancer Society 2006)

• BRCA2 mutation increases risk of prostate, breast, pancreatic, stomach cancer, and melanoma (Liede et al 2004)

• The association between prostate cancer and the Y-chromosomal haplogroups (The incidence rate of prostate cancer in African-American males is two times higher than Caucasian men and ten times higher than Japanese men) (Ewis et al 2006)

• CHEK2 mutation – doubles risk of prostate cancer and quadruples risk in men with family history (Cybulski et al 2006)

Somatic causes of cancer

• More than a third (37%) of all risk-factor attributable deaths are from:

– Smoking

– Alcohol use

– Low fruit and vegetable intake

– Overweight & obesity

– Physical inactivity

– Urban air pollution

– (unsafe sex, indoor smoke, contaminated injections)

(Danaei et al 2005 Lancet 366: 1784–1793

Hospital admissions and contacts to general practitioners. Sex ratio (female/male rate) by age group, Denmark 2005.

Juel & Christensen (2007) Are men seeking help too late? Contacts to

general practitioners and hospital admissions in Denmark 2005. Journal of

Public Health Advance Access published 2nd November 2007

Consultations with doctor – Proportion of rates per 10,000 person years at risk by ‘serious’ category of

severity by sex, age 25-44 years

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

50.00

All d

isea

ses

and

cond

ition

s

Infe

ctio

us a

nd p

aras

itic

dise

ases

Neo

plas

ms

Endo

crine,

nut

& m

et d

is a

nd im

m d

is

Bloo

d an

d bloo

d-fo

rmin

g or

gans

Men

tal d

isor

ders

Ner

vous

sys

tem

and

sen

se o

rgan

s

Circ

ulat

ory

system

Res

pira

tory

sys

tem

Dig

estiv

e sy

stem

Gen

itour

inar

y sy

stem

M/S

sys

tem

and

con

nect

ive

tissu

e

Inju

ry a

nd p

oiso

ning

Percentage (%)

Male

Female

1

Consultations with doctor – Proportion of rates per 10,000 person years at risk by ‘minor’ category of

severity by sex, age 25-44 years

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

All dise

ase

s an

d co

ndition

s

Infectious

and

par

asitic dise

ases

Men

tal d

isor

ders

Ner

vous sy

stem

and

sen

se org

ans

Circ

ulator

y sy

stem

Res

pira

tory sys

tem

Diges

tive sy

stem

Gen

itourin

ary sy

stem

Skin and

subc

ut tiss

M/S

sys

tem

and

con

nective tis

sue

Sym

ptom

s, signs

and

ill-d

efin

ed

Injury and

poiso

ning

Percentage (%)

Male

Female

All consultations with doctor – Proportion of rates per 10,000 person years at risk by ‘serious’ category of

severity by sex and age

Calculated from McCormick, A Fleming, D, Charlton J (1995) MorbidityStatistics from General Practice Fourth national study 1991-1992 , HMSO

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Total 0-4 5_15 16-24 25-44 45-64 65-74 75-84 85+

Percentage (100%)

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 Rasand 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

Conclusion

• Men are at increased risk of many cancers that should affect men and women equally.

• The causes of cancer are many and varied, both inherited and acquired.

• There are biological and lifestyle factors that seem to make men specifically vulnerable to developing cancer.

• But no systematic study of men’s increased risk of cancer yet undertaken.

Men's Health: How to Do It

by David Conrad &

Alan White (Eds.)

Foreword by Ian Banks

Radcliffe Publishing £21.95

Hazardous Waist:

Tackling Male Weight

Problems

by Alan White &

Maggie Pettifer (Eds.)

Foreword by

Peter Baker

Michael Kimmel

Radcliffe Publishing £24.95

The state of men's health - Nordic conference-printable · Journal of Men’s Health & Gender 3(2):...

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