Foe whatever the physical virtues of maleness, longeivity is not among them. Every year, almost 1,00,000 men are dying prematurely compared to 66,000 women. Women live longer than men

1. DR. PRABHJOT SAINI
R N R M M S N P H D
PROFESSOR & HEAD
MEDICAL-SURGICAL NURSING DEPT.
DMCH COLLEGE OF NURSING
LUDHIANA
Men die more with cancers
than women

2. Fact of life
 It is a fact of life that men enjoy certain physical
advantages over women.
 On average, men are stronger, taller and faster.
But none of these attributes seem to matter over
the long haul

3. Reality check
 For whatever the physical virtues of maleness, longevity
is not among them.
 Every year, almost 100,000 men are dying prematurely
compared to about 66,000 women (according to figures from the
charity Men’s Health Forum)
Women live longer
than men.

4. Reality check
 Women outlive men, sometimes by a margin of as much
as 10 years.
 In the U.S., life expectancy at birth is about 79 years for
women and about 72 years for men.

5. So what’s going on !!!!

6. The Epidemiology: What
Is Known??

7. SCENARIO
 Globally, 4.6 million men die of cancer every year - 126 per
100,000.
 As compared to 3.5 million women die of cancer each year- 82
in every 100,000.
 Nearly all common cancers show elevated incidence rates in
men compared with women.

8.  Excess incidence and mortality in men can be explained
by men’s great exposure to known risk factors: e.g.
smoking, alcohol.
 This male excess may result from a general biological
predisposition.
 Men have poorer survival than women.

9. Global scenario
 There is a higher mortality and incidence rates for cancers
among men in developed and developing countries.
 Cancers in men are more likely to cause death (80,000
male deaths compared with 73,000 female deaths).
 Overall, cancer causes 28% of male deaths and 23% of
female deaths.

11. Incidence Of Cancer in men

12. Incidence of cancer in men
 Prostate, lung and colo-rectal cancers account for roughly half
of all cancers in men.
 Incidence of prostate cancer has increased dramatically in
recent years.
 Incidence and mortality rates for lung cancer & oral cancers
have always been higher in men because of higher smoking
rates among men in earlier decades.
 Colo-rectal cancer shows a substantially elevated risk in men.

13. Mortality Rates

14. Mortality Rates
 Men are 50% more likely to die from cancer than women-
According to new global statistics.
 Men’s lifetime risk of developing a non sex-specific cancer is
35% compared with women’s risk of 25%.
 The gender gap is even wider (sex-specific forms of the disease
such as prostate, testicular and ovarian cancer are excluded),
with men 67% more likely to die.

15.  If lung cancer is removed from the calculation, the excess
mortality rate in men actually rises by 0.5%.
 Working aged men under 65 have a 58% greater chance of
dying than women of the same age.
 Death from oesophageal cancer is four times more common in
men in the under 65 age group.

17. Cancer Death Rates
Top five biggest disparities in cancer death rates were for the
following types of cancer :
 Cancer of the lip: 5.51 men died for every one woman
 Cancer of the larynx: 5.37 men died for every one woman
 Cancer of the hypopharynx: 4.47 men died for every one woman
 Cancer of the esophagus: 4.08 men died for every one woman
 Cancer of the bladder: 3.36 men died for every one woman
A study published in Cancer Epidemiology, Biomarkers and Prevention

18. Key facts on Men’s health

19. Key facts on men’s health
 Life expectancy for men are lower than women.
 Men tend to smoke more than women
 Men tend to drink more than women
 Men don’t seek medical help as often as women
 Some men define themselves by their work, which can add
to stress

20. Reduced survival rates of Men

21. Sex ratio
 Sex ratio in India 2016 shows :
1000 males are born for every 944 females
 But still the numbers of men are preferentially whittled
down thereafter.

22. Reduce survival rates of Men
 Survival rate for boys is lower because of spontaneous
abortions, stillbirths and miscarriages of male fetuses.
 More boys than girls die in infancy.
 Mortality rates for males exceed those for females, so
that by age 25, women are in the majority.

23. What are Theories behind
reality??

24. These statistics raise two questions:

25. Theories behind reality
Biological
Toxic testosterone
Chromosomal diff.
Immunological
Ferromagnetic

26. Biological Explanation
 Female sex hormones may be protective against some
cancers
 Men may be more susceptible to oxidative damage to
body cells
 Women derive protection from their more vigorous
immune system

27. Toxic Testosterone
 Experts suspect that gender differences in mortality patterns
may be influenced at least in part by sex hormones:
 Testosterone: it puts men at risk biologically as well as
behaviorally. It increases blood levels LDL, and decreases levels
of HDL, putting men at greater risk of obesity related cancers
 Estrogen acts as antioxidant, it neutralizes certain oxygen
radicals, that have been implicated in causing cancer.

28. Survival of the Fittest
 Females tend to live longer than males in all species.
 It seems that a species' life span is roughly correlated
with the length of time that its young remain
dependent on adults.
e.g.
 Female macaques live 8 years longer than males
 Female sperm whales outlive their
male counterparts by an average of 30 years.

29. Historical Advantage
 Women have more chronic nonfatal conditions--such as
arthritis, osteoporosis and autoimmune disorder.
 Men having more fatal conditions, such as heart disease and
cancer.
Women live with their
diseases while
Men die from them……

30. Ferromagnetic Cancer Theory
 Intracellular molecules (FeO;Fe2O3;Fe3O4) are the main
'creators' of ferromagnetic nanoparticles.
 These nanoparticles create invisible local magnetic fields.
 When DNA or chromosomes come close to this region of space,
they feel a pull or a push from the magnetic nanoparticle.
 DNA and chromosomes get defects and disruptions.
 This Magnetism causes cancer.

32. Iron load
 Iron is essential to most life forms and to normal human
physiology.
 On the other hand, excess amounts (deposits) of iron can result
in toxicity and cancer.
 Iron is a well-known carcinogen and may favor tumor growth.
 Women (2.4gm) are relatively iron-deficient compared to men
(3.6gm) - - because of menstrual bleeding and pregnancies.
Men are at higher risk of getting cancer.

33. Chromosomal differences
The sex-determining chromosomes (X chromosome) can carry
genetic mutations
 Women: have two X chromosomes, an abnormal gene on one X
chromosomes can be replaced by the normal gene on the other
and thereby avoid the expression of disease.
 Men: have one X chromosome and one Y chromosome, and so they
cannot rely on an alternative chromosome if a gene on one of the
sex chromosomes is defective, thereby compromising body's
ability to repair the mutations.
Researchers at Stanford University reported the discovery on the X chromosome of a gene
critical to DNA repair, 1985

34. Immunologic difference
 The female immune system is known to produce a more
vigorous response to “biological insult” than the male
immune system.
 Women have greater resistance to certain infections and
have higher incidence of autoimmune diseases.
 Some research suggests that stronger immuno-
surveillance affords some protection against cancer

35. Role of antioxidants
 A poor diet is a risk factor for some cancers
 Men tend to exhibit more oxidative damage to cells than
women.
 The environmental effect of oxidation-causing agents is greater
in men than in women.

36. Men at higher RISK
of developing
cancer!!

37. DIFFERENCES IN SMOKING,
ALCOHOL USE, DIETARY
INTAKE AND SO ON….
Lifestyle differences between
men and women

38. Classification of cancers
(as per the attributable factors)
 The two classes are :
 Germline cancers
those that are attributable to inherited factors)
 Somatic cancers
those whose causes are acquired during the lifespan

39. Germline cancers
 Various genetic mutations can be passed down through
families making family Risk of developing cancer.
 The association between some specific cancer risks and
the known “vulnerability” of the XY (male) chromosome.
 Cancer cells may replicate more quickly in men.

40. Cancers associated with Germline
 Prostate cancer is associated with Y-chromosomal changes.
 Inherited risk causes CHEK2 mutation, doubling the risk of
prostate cancer & quadruples with family history of the disease.
 Standardised incidence ratios for testicular cancer suggest a
familial association (risk increased 3.8-fold when a father had
testicular cancer and 7.6-fold when a brother had the disease).

41. Somatic cancers
 It is believed that around 37% of cancers can be attributed to a
group of specific lifestyle and environmental risk factors:
 Smoking
 Alcohol use
 Low fruit and vegetable intake
 Overweight and obesity
 Physical inactivity
 Urban air pollution

43. Smoking & Cancer
 Smoking is known to contribute to the risk of around 16 different
cancers, with lung cancer of course.
 Men smoke more than women in all age groups.
 29% - 38% of cancer deaths linked to smoking in men, as
compared to 2% - 10% in women.

44. Alcohol & Cancer
 10% of cancers diagnosed in men are thought to be associated
with alcohol, compared with 3% in women.
 Alcohol consumption is thought to stimulate angiogenesis,
unhelpfully increasing blood supply to existing cancers.
 Men more likely to drink at all times to hazardous levels & binge
drink

45. Alcohol & Cancer
 Men likely to drink alcohol daily (18% of men & 9% of women).
 Boys start drinking at an earlier age.
 Younger men in the lower socio-economic groups are the
heaviest drinkers.

46. Men & Diet
 Men tend to have a less healthy diet overall
 Men show a much lower interest in nutrition.
 Men are less likely to eat the recommended five portions
of fruit and vegetables daily.

47. Men & Obesity
 Overweight men are less concerned about excess weight.
 Ten percent of all deaths are believed to be associated with
obesity.
 Several cancers risks are known to be exacerbated by obesity –
including kidney cancer, cancer of the gall bladder, pancreatic
cancer and prostate cancer.

48. Men cancer & Obesity
 Men are more likely than women to gain fat around their
abdomen.
 Abdominal fat secrets “fat toxins” e.g. leptin- associated with
increased cancer risk (prostate cancer).

49. Men & Physical Inactivity
 Both excess and too little exercise are associated with increased
risk of cancer.
 The numbers of men in sedentary occupations has grown very
significantly in recent decades.
 Younger men are more attracted towards 6 pack Abs and heavy
exercises….posing them to cancer risk.

50. Why men are at risk ??
 Men’s approach to food is often “pleasure-oriented”
 “Bigness” with large body frame is associated with more
dominant notions of masculinity
 Increasing numbers of men have sedentary occupations.
 Levels of physical activity in men declines with age.
 ‘Eating & Gyming’ is the rule for younger men (masculin nature)

51. Occupational exposure
 Men are much more likely than women to come into
contact with a wide variety of potentially hazardous
chemicals and materials (carcinogens).

52. Men & Immunity
 Women are known to have both stronger humoral
immune systems than men and stronger cellular immune
systems.
 This means they have a more vigorous antibody reaction
and greater resistance to viral and parasitic infections.

53. Men & Age
 Men are likely to develop and die from particular
cancers at younger ages than women.
 Colo-rectal cancer: men die 5 – 10 years earlier than
women.

54. Treatment Seeking Behavior

55. Treatment seeking behaviour
 Men are more likely than women to delay seeking help
 Men exhibit negative attitudes towards disease prevention
interventions than women
 Cancer screening is much less established for men than for
women.
 Fear of a positive result put men off
 Men do not take up screening .

56. Factors for delay in men
Lack of
symptom
recognition
Belief that
symptoms
will go
away
Help-seeking
as un-
masculine
Fear of loss
of sexuality
post
treatment

57. Men’s knowledge, Attitude &
Awareness

58. Factors for late diagnosis among men
 NAEDI’s has pointed towards three factors for late
diagnosis of cancer among men:
Low public awareness
Late presentation
Symptoms are vague or masked

59. Factors for late diagnosis among men
 Threat : They do not believe their symptoms to be severe
enough to matter
 Barriers : personal circumstances e.g. the patient can’t
afford the time off work) and patient’s perception that he
or she will be seen as wasting the doctor’s time.
 Cues to action: Cues to action may come from friends
and relatives or from the media or from health promotion
messages.

60. Do men & women with similar
cancers receive similar treatment ???

61. Cancer treatment options among sexes
 Men are significantly more likely to receive all three
aggressive forms of treatment for cancer.
 Oesophageal cancer: More women are treated by
radiotherapy; more men by chemotherapy
 Stomach cancer: More men are treated by both radiotherapy
and chemotherapy
 Rectal cancer: More men than women are treated surgically
 Lung cancer: older patients men are more likely to be treated
surgically. Men are more likely to receive radiotherapy at all
ages.

62. Survival among men

63. Survival among men
 Studies in Europe have shown a general pattern of poorer
survival for men.
 Five year survival for melanoma and lung cancer was
similar for men and women .
 Five year survival for other three cancers was
significantly lower in men: 44% lower for colorectal
cancer; 27% for bladder cancer and 44% for stomach
cancer.

64. Additional factors for survival
 In addition to male sex, a number of other factors was
associated with poorer survival :
 being older (especially being over 75)
 being single, divorced, widowed or separated
 being a smoker
 presenting disease at a later stage
 Tumour site
 histological classification
 Men still have poorer survival rates than women.

65. Can we reduce cancer incidence in
men? ?

66. Signs of Hope
 Screening policies for men should be made mandatory
 DRE & PSA annually for men >50Years
 Begin screening at age of >45 years (with first degree relative
having cancer diagnosed at young age)
 Develop male-specific interventions to tackle poorer lifestyle.
 Concentrate particularly on men of lower socio economic status

67. Signs of Hope
 Develop male- specific symptom awareness campaigns.
 The National Curriculum should include education – particularly
targeted at boys – about how to take maintain good health and
how to use health services effectively.
 Try out approaches that are effective among men e.g. workplace
interventions or phone/email consultation.

68. We need more and better researches :
 To reduce the percentage of cancers that currently have no
known cause.
 To quantify the proportion of the gender difference that can
currently be explained by known cases.
 To better understand how to develop public health
interventions that are effective with men.

69. Summary
 Men develop and die from virtually all cancers
 Men delay seeking help.
 Higher incidence among men depend upon a complex mix of
biological, social and environmental factors.
 Higher incidence may vary from one type of cancer to another.
 Cancer prevention programmes and campaigns are less effective
with men than women
 The knowledge base of men regarding various aspects of cancer
is poorer
 Men and women with the same cancer may sometimes be
offered or choose different treatment options leading to
differences in outcomes.

70. Any Queries !!!!!!