“Men’s Rights Activism” (MRA) is a dirty phrase in many circles. The MRA movement is a fairly diverse beast ranging from claims of inequality in child custody cases to accusations of full-blown, societal-scale misandry typified by higher death rates in men and lower levels of social investment. One claim in particular that the MRAs make is that breast cancer (a cancer that predominantly, though not entirely, affects women) receives substantially more money in terms of research funding than prostate cancer, despite similar numbers of people dying from each. First I’ll review some of the specific claims made, I’ll look at the data on funding, then we can delve into a few stats on the impacts of these two cancer types (bear with me!). I’ve also included some more detail on whether younger men are more at risk from prostate cancer as an appendix for those who are interested.
Here are some verbatim examples of the claims:
The amazing advances that have been made in the treatment of Breast Cancer is stemmed from the amount of funding that the Breast Cancer Research program has received over the decades. The two forms of cancer seem to be as problematic as each other, however Breast Cancer Research receives at least 75% MORE funding than Prostate Cancer Research.
The number of men who contract prostate cancer is about the same as the number of women getting breast cancer. The disparity in annual, government research funding between the two cancers is striking and discriminatory, illustrating yet again the institutionalized misandry existing in Western societies, in my opinion.
– Ray Blumhorst, National Coalition for Men
This year  218,890 men in the U.S. will be diagnosed with prostate cancer, according to the American Cancer Society. By comparison, 178,480 new cases of breast cancer will be diagnosed in women. Not a huge difference, but a new report finds that for every prostate cancer drug on the market, there are seven used to treat breast cancer, and federal spending on breast cancer research outpaces prostate cancer spending by a ratio of nearly two to one.
– Business Week, via the National Prostate Cancer Coalition
“…prostate cancer is just as deadly as breast cancer yet receives only a fraction of the funding and that the myth that prostate cancer only affects old men just isn’t true. It’s weird, but new studies show that younger men with certain aggressive forms of the disease are actually more prone to dying quicker.”
– Canadian Association for Equality promotional video
The specifics of the claim vary over time and between countries, but the similarities seem to be:
- Prostate cancer research receives less funding than breast cancer.
- Prostate cancer affects at least as many men as breast cancer affects women.
It is these claims that I will look at now.
Funding for breast and prostate cancer
There are certainly going to be international variations in the amount of funding given to different cancers. I have chosen data from the UK and the US because those countries make their data available. If anybody has a source for other countries, I would be happy to include it as an addendum. The data for the UK is the expenditure by Cancer Research UK (specifically from this report), the world’s largest independent cancer charity, which (as the name suggests) conducts research on prevention, diagnosis and treatment of cancer. The US data comes from the http://www.cancer.gov website (specifically here, supplemented with 2011 data from here).
As you can see, there is a substantial difference in the funding of prostate cancer and breast cancer research in both the UK and the US, and this gap doesn’t seem to be closing. So maybe the MRAs have a point?
Incidence and mortality of prostate and breast cancers in the US
I’m going to look at two variables: incidence (the number of cases) and mortality (the number of deaths). In each case, the numbers are from the US (because the US cancer stats are mostly easily accessible, from here) and are expressed as the number of cases or deaths per 100,000 population. As you can see from the data, throughout the 1970s and most of the 1980s there were similar numbers of men suffering and dying from prostate cancer as there were women suffering and dying from breast cancer. However, in the early 1990s the prostate cancer incidence spikes, along with the number of men dying from prostate cancer. Following that spike, we see a levelling-out of cases with prostate cancer affecting about 20% more men than breast cancer affects women. The good news is that the number of people dying from each seems to be falling year on year. Again, the MRAs seem to be right: there are more cases of prostate cancer and the mortality rate is at least as high as for breast cancer. So are they right to feel aggrieved?
The problem with the MRA argument is that the statistics hide the details of what is actually going on with the two diseases. Yes, more men are suffering from prostate cancer, and yes, equal numbers are dying, but who are those men? We can use the US data to take a closer look.
The following statistics look at the age distribution of the (i) the incidence, (ii) the population-level mortality (i.e. the number of people who are dying), and (iii) the individual-level mortality (i.e. the probability of dying if you contract the disease) for prostate and breast cancer. The data are all from the same http://www.cancer.gov website that I cited above. What you can see is that prostate cancer doesn’t affect men until their mid/late 40s (top graph). Breast cancer, on the other hand, is affecting many more younger women. Prostate cancer also kills relatively few men under the age of 70. Bearing in mind that the average life expectancy for men in the US population was 75.9 in 2010 (source), that means that you have to almost reach the average life expectancy before this particular cancer will be much concern. Note that breast cancer kills many women who are in middle-age (40-60 yrs old, middle graph). These differences in population level mortality statistics stem from a difference in survival between the two cancers. If you contract breast cancer at age 25, you have approximately a 10% chance of dying and by age 50, this chance rises to 15%. In contrast, mortality rates are very low (<5%) for prostate cancer until men pass 70 years of age.
Is prostate cancer more aggressive in younger men?
You might have noticed that there are two additional claims made in the fourth quote that I presented above, the first of which is “The statement that prostate cancer only affects old men isn’t true” – this is a straw man argument that misses the point. The data is clear that younger men are affected, but these cases are rare compared to cases of breast cancer in younger women, and the probability of survival is very high. The second statement, “new studies show that younger men with certain aggressive forms of the disease are actually more prone to dying quicker“, is a more detailed point backed up with actual scientific references so it deserves a closer look. However, this is a detailed issue so I have put the discussion in an appendix at the foot of this post for those who are interested. Basically, it seems to be a poorly supported theory that was common in the 1960s.
A few take home messages:
- Breast cancer and prostate cancer affect different people, not only in terms of gender but also in terms of age.
- Breast cancer kills young women and kills mothers while their children are young. The reason for our fear (and, as a result, our funding) of breast cancer is that it can strike at almost any time and poses a considerable risk when women do suffer from it.
- Prostate cancer, by and large, kills older men. While no less of a tragedy, these men have lived long lives and are at greatly increased risk from a range of other ailments (heart disease among them). The theory of more aggressive prostate cancers in younger (whatever that means) men is poorly supported.
- The MRA movement cites statistics that do not reveal these important differences.
- Finally, the priorities of funding agencies are not simply the number of people dying from a particular condition. The funding landscape is complex, designed around current advances, where the best researchers are located, the best proposals for funding, political will, and a host of other variables.
Now, I am not saying that we should not research prostate cancer. Indeed, Movember is coming up and I would encourage everyone to contribute or participate (you can also donate to Cancer Research UK). However, when we have limited resources, we have to make difficult decisions about how to allocate those resources. In this case, breast cancer has a greater societal impact through greater mortality at younger ages and that is why we can justifiable provide greater funding to breast cancer research.
APPENDIX: Age and prostate cancer
The notes from the video point to the Cancer Research UK website that references these two studies. First of all, the two studies are from 1994 and 2002, so they are not exactly new. We’ll take them one by one:
Gronberg et al., 1994 – Gronberg and colleagues don’t demonstrate that prostate cancer is any more aggressive in younger men. In fact, the article even states in the abstract “This finding does not support the view that tumors appearing in younger patients are more aggressive per se”. The interpretation of their results that the MRAs adopt stems from a consideration of “loss of life expectancy” as the outcome, rather than death. When a younger man dies, this is a greater number of potential life years lost than if an older man dies. In this sense, prostate cancer is worse for younger men but the study said nothing about the disease itself affecting people differently (the survival rate was the same).
Merrill and Bird, 2002 – These authors did actually look at the survival of men in different age groups and did find a difference between ages. They describe a lower survival in younger and older men, with a peak in survival at intermediate ages.
It is worth, however, putting these two studies into context, since there has been much research conducted since:
- Freedland et al (2004) found that young men had more favourable outcomes after surgical radical prostatectomy (RP) than older men.
- Herold et al (1998) found that age of the patients greater than 65 years was a significant predictor of distant metastases at 5 years.
- Obek et al (1999) suggested that young age per se might be an independent favourable prognostic factor for disease recurrence after surgical radical prostatectomy.
- Austin and Convery (1993) showed that younger white men survived better than older white men, but that younger black men survived less well than older black men.
- Konski et al. (2006) show that men age ≤55 years who present with localized prostate cancer do not appear to have a worse prognosis. They also note that “In the pre-PSA era, younger age was believed to convene a poorer prognosis because it potentially signified more virulent disease”, suggesting that this is in the past. They cite Merrill and Bird as a study that shows this effect.
- Hamstra et al. (2011) suggest that older men (defined as >70 years old) have better recovering after radiation therapy than younger men.
- Wang et al. (2011) show that for a very rare form of prostate cancer (signet ring prostate carcinoma) there is lower survival in younger men.
- Lin et al. (2009) find that younger men were more likely to… have better overall and equivalent cancer-specific survival at 10 years compared with older men. However, they also note that high grade and locally advanced prostate cancer was associated with a worse prognosis in younger vs older men. They cite a wide range of studies demonstrating that recovery is more likely and treatment complications are reduced in younger men. They also raise the problem of defining “young” in the case of prostate cancer studies, since this can mean anything from less than 50 years to less than 60 years depending upon the study. Neither of these corresponds to “young” in common parlance…
In summary, the picture is far from clear and most studies seem to suggest that younger men have a better prognosis than older men. The example cited in the MRA literature (Merrill and Bird, 2002) appears to be the only convincing result in favour of their hypothesis, while many other studies contradict that result. Also, the lack of a consistent definition of “young” (whatever is used in the studies tends to be considerably older than what most people would consider “young”) makes these studies difficult to interpret.
Austin JP, Convery K (1993) Age-race interaction in prostatic adenocarcinoma treated with external beam irradiation. Am J Clin Oncol. 16(2):140-5.
Konski, A., Eisenberg, D., Horwitz, E., Hanlon, A., Pollack, A. and Hanks, G. (2006), Does age matter in the selection of treatment for men with early-stage prostate cancer?. Cancer, 106: 2598–2602.
Freedland SJ, Presti JC Jr, Kane CJ, Aronson WJ, Terris MK, Dorey F, Amling CL, SEARCH Database Study Group. (2004) Do younger men have better biochemical outcomes after radical prostatectomy? Urology, 63(3):518-22.
Gronberg, H., et al., Patient age as a prognostic factor in prostate cancer. J Urol, 1994. 152(3): p. 892-5.
Hamstra D.A. et al. (2011) Older Age Predicts Decreased Metastasis and Prostate Cancer-Specific Death for Men Treated With Radiation Therapy: Meta-Analysis of Radiation Therapy Oncology Group Trials, International Journal of Radiation Oncology * Biology * Physics, 81,(5): 1293-1301.
Herold DM, Hanlon AL, Movsas B, Hanks GE (1998) Age-related prostate cancer metastases. Urology, 51(6):985-90.
Lin, D. W., Porter, M. and Montgomery, B. (2009), Treatment and survival outcomes in young men diagnosed with prostate cancer. Cancer, 115: 2863–2871.
Merrill, R.M. and J.S. Bird, Effect of young age on prostate cancer survival: a population-based assessment (United States). Cancer Causes Control, 2002. 13(5): p. 435-43.
Obek C, Lai S, Sadek S, Civantos F, Soloway MS (1999) Age as a prognostic factor for disease recurrence after radical prostatectomy. Urology. 54(3):533-8.
Wang, J., Wang, F.W., and Hemstreet, III, G.P., (2011) Younger Age Is an Independent Predictor for Poor Survival in Patients with Signet Ring Prostate Carcinoma, Prostate Cancer, vol. 2011, Article ID 216169.
Prostate photo by Netha Hussain. Graphs are all mine based on data cited.