Movember: just another gimmick?

Take a look at the guys around you this month and count how many of them are displaying more facial hair than usual.

Chalk it up to Movember, a global charity event that invites men to grow mustaches during November to raise awareness and money for men’s health. According to the website, the initiative had more than 854,000 participants – they’re known as “Mo Bros” – worldwide last year and raised $126 million on behalf of prostate and testicular cancer.

Well, fair enough. After all, the entire month of October is devoted to breast cancer awareness and fundraising and all things pink. Maybe it’s time men had their own health month.

But the critics are cautioning: Don’t be too quick to get behind this health campaign without asking more questions about what’s really being accomplished.

What is the substance behind the “awareness” the Movember campaign says it promotes? Take a look at the list of Movember health tips, which include a recommendation to get an annual physical: “Getting annual checkups, preventative screening tests and immunizations are among the most important things you can do to stay healthy.” Nary a mention is made of the debate surrounding the value of the yearly physical exam. Nor is there discussion about the risks vs. the benefits of prostate cancer screening, an issue that’s of considerable controversy amongst the medical and scientific community, or how men can weigh the evidence to make appropriate, informed decisions.

Another health checklist on the website advises men 40 and older to talk to their doctor about the use of aspirin and statins to lower their risk of heart disease, even though the preventive benefit of these two therapies has not been clearly established in people who don’t have existing heart disease.

Most would agree men are well served by education that gives them accurate, realistic information about their health. Are they served as well by information that’s overly simplified or that fails to adequately convey evidence-based pros and cons? Or by messages that confuse screening with prevention?

Perhaps the bigger issue is whether Movember, which started out with good intentions, is turning into a gimmick that allows people to feel good about a cause merely by growing a mustache and donating a few dollars.

Blogger Ashley Ashbee calls it “a type of slacktivism.”

“Does your moustache share information about the importance of screening, or where to get screened?” she wrote last year. “Does it tell you how you can prevent prostate cancer (if you even can)? Does it tell you the symptoms? Does it tell you who’s affected?”

Moreover, critics say one of the flaws of catchy public awareness campaigns, whether they’re exemplified by mustaches or by pink ribbons, is that they can skew the public’s perspective about risk and disease and lead to inaccurate or exaggerated beliefs that sometimes spill over into health-related behaviors. Although prostate cancer is far and away the most commonly diagnosed type of cancer among men in the United States, it’s actually lung cancer that is responsible for the most cancer deaths in men. Heart disease continues to be a significant health risk for men and, many would say, is the leading male health issue. Men also outnumber women when it comes to alcoholism, fatal traffic crashes and suicide.

To their credit, the Movember organizers added men’s mental health this year to their list of causes. But whether this helps improve the public’s understanding about male health remains to be seen.

The Toronto Globe and Mail spoke last week to medical ethicist Kerry Bowman of the University of Toronto, who lamented, “There’s not a direct relationship between the diseases we hear most about and either their occurrence in society or the lethality and the amount of suffering they create.”

Ideally, there should be a form of “ethical triage” that helps the public be better informed about the most widespread and urgent health care needs before donating their money to a cause, Bowman said. But for most fundraising campaigns, this kind of analysis is “very much lost,” he said.

Men in pink

Amid October’s pink tide of breast cancer awareness, there’s one demographic that’s all too often overlooked: men with breast cancer.

Yes, guys get this disease too.

I was reminded of that fact earlier this week when the Mayo Clinic tweeted a link to a story that appeared a few years ago in the Sharing Mayo Clinic publication. It’s the story of Craig McMillan, a 59-year-old insurance agent from Florida who was diagnosed with breast cancer in 2004 and underwent a double mastectomy followed by chemotherapy and radiation.

Was it a shock? Absolutely. “Like most men, I thought it was a women’s disease, so I was in denial and didn’t think it could happen to me,” McMillan told the Mayo magazine.

His wife, Jane, said she had never even heard before of breast cancer among men. “After the diagnosis, we found out that three other men we know have also survived breast cancer,” she said. “I guess this is an issue that men just don’t like to talk about.”

Some facts about male breast cancer:

- It’s rare, which may account for why many people remain unaware of it. About 2,000 new cases are diagnosed in the United States each year, and about 400 men die of male breast cancer. To put it in perspective, men account for about 1 percent of all new breast cancers annually in the U.S.

- The cause remains unknown. Research suggests that acquired or inherited gene mutations may play a role – primarily the BRCA1 and BRCA2 genes, which are thought to be a factor in 5 to 10 percent of breast cancers among women. Men with either one of these genes face a higher lifetime risk of breast cancer but apparently less so than women with one of the BRCA genes.

- As with women, the risk of breast cancer among men tends to increase with age, family history (McMillan’s grandmother and sister both had breast cancer, and both his parents had lung cancer), heavy drinking and estrogen treatment. There also seems to be a link with environmental exposure, such as medical radiation or occupational exposure, although more research is needed on how strong this link might be for male breast cancer.

- Treatment options are the same for men as for women: surgery, radiation, chemotherapy, hormone therapy and some of the newer targeted therapies.

- Breast cancer actually is easier to diagnose in men because they have less breast tissue, making lumps easier to spot while they’re still relatively small. Lack of awareness, coupled with embarrassment, is more likely with men than with women, however, and can lead to delays in diagnosis and treatment. Also, male breast cancer unfortunately doesn’t need to grow very far to spread to nearby tissue or lymph nodes, which means their cancer may be at a more advanced stage by the time it’s diagnosed.

- Men with breast cancer seem to have better survival rates than women – but survival for male breast cancer has been increasing at a slower rate than for female breast cancer.

- Men are not well represented in the research on breast cancer. Much of what we know about male breast cancer stems from studies made up mostly of women who have the disease.

How men fare emotionally when they go through diagnosis and treatment for male breast cancer seems to be similar to anyone else who has cancer. After all, much of this terrain is universal, regardless of gender, age or diagnosis. But it surely must be more complicated, and more isolating, for many men. It’s hard to picture how comfortable they might feel as the lone guy at a mammography center. Are they marginalized by the symbolic pink ribbon – and if so, does this make their experience more difficult than it needs to be?

if ever there was a case to be made for avoiding one-size-fits-all approaches to how we talk about cancer and how we respond to those who have the disease, this would be it.

Guys and health

If the movies, TV and popular magazines are to be believed, the most important health issues for men consist of: receding hairlines, sex, heart health, sex, fitness, sex, sex, prostate health and sex.

Perhaps these all have some basis in fact. But real men’s health is considerably more nuanced than the many stereotypes would suggest.

In honor of Men’s Health Week this week, let’s take a closer look at men and their health:

- Most adult American men are healthy, or at least view themselves as healthy. According to the National Health Interview Survey for 2009, only 12 percent of the men 18 and older who were interviewed reported their health as fair or poor.

- The leading causes of death for American men, in descending order, are heart disease, cancer and accidents/unintentional injuries. (For women it’s heart disease, cancer and stroke; injury is sixth on the list.)

- Men have a lower life expectancy than women.

- Men are more likely than women to drink excessively. They’re more likely to binge-drink and more likely to meet the criteria for alcohol dependence. They also have higher rates of alcohol-related hospitalizations and deaths than women.

- Although it’s often thought women are more likely to have depression, men can be depressed too – and when they are, it frequently goes undiagnosed. This is partly because men might ignore their depression or refuse treatment. Depression also can be harder to recognize among men because it manifests itself differently than among women. It can take the form of anger; aggressive or risky behavior such as reckless driving; alcohol or substance abuse; infidelity; and escapist behavior such as spending long hours at work or in sports.

- Men are underrepresented in the doctor’s waiting room. According to CDC statistics, about 20 percent of men don’t see a doctor at all; the comparable figure for women is 10-12 percent. Many men, especially young men, may be missing out on opportunities to assess their health and lower some of the risks they face.

- Prostate cancer is the most common form of cancer diagnosed among men but there’s often confusion about when they should be screened. The recommendation from the U.S. Preventive Services Task Force: There’s insufficient evidence on the benefits vs. the harms of routine screening for prostate cancer, and screening isn’t recommended for men older than 75. The American Cancer Society echoes these guidelines. The advice from the ACS: Men should talk to their doctor and make an individual decision on whether to be tested.

Health care traditionally has been male-oriented, leading to some significant gender imbalances in what we know about health, sickness and wellness. But just as women haven’t always received a good deal when it comes to understanding their health, men haven’t always gotten a good deal either. Getting past the stereotypes is a constructive way to start making this better.

Photo: Scott Bakula, Ray Romano and Andre Braugher in “Men of a Certain Age.” Photo courtesy of TNT.