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Breast Cancer, Osteoporosis, Cystitis and the Menopause in Men

A Report from the UK

(In cooperation with the "Men's Health Links" page of the Stejonda site in the UK.)

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Any diagnosis of a serious condition is going to throw even the most sanguine patient off their stride, but when that condition is one that people believe affects only the opposite sex, then coming to terms with illness can be even harder. Although it is rarely said outside medical circles, men can suffer from "women's problems" - and not just minor complaints such as cystitis, but serious illnesses such as osteoporosis and breast cancer.

Brittle bone disease, or osteoporosis, which is caused by a loss of calcium in the bones, is one of a number of illnesses widely perceived to affect only women. As a consequence, although it may strike as many as 1 in 12 men, few do anything to prevent its onset. Osteoporosis is more common in post-menopausal women, about 25% of whom will develop the condition, but the notion that this is a woman's disease makes it harder for men to come to terms with their illness.

Men and women would benefit from taking preventive steps. Exercise, for example, is crucial to building bone density in both sexes. According to research by scientists at Nottingham University, just 50 jumps a day can improve average bone density by 4%.

Dr Roger Francis, a consultant physician at Newcastle's Freeman hospital, says: "Male osteoporosis is increasing because, these days, most of us lead a more sedentary lifestyle."

His advice to men who want to minimise the risk includes stopping smoking, avoiding excessive drinking and increasing the amount of weight-bearing exercise (such as walking and running). Nutritionists also recommend increasing consumption of calcium-rich foods, including milk, cheese and yoghurt.

Although osteoporosis is more common in men over 60, the age at which the disease occurs is less important than its severity and its impact on quality of life. Sometimes the condition can develop for no apparent reason, but more often it is the result of some other underlying health problem. Chronic asthma sufferers, for instance, are at greater risk because long-term use of steroids can lead to brittle bones. Sufferers from coeliac disease, which affects the body's ability to absorb calcium, and men with abnormally low levels of testosterone are also susceptible.

Believe it or not, men are not even immune to breast cancer. Although far more common in women - for whom the incidence is as high as 1 in 12 - it also affects 1 in 100,000 men. (more info below)

Breast Cancer Care, a support group for women and men who have been diagnosed with breast cancer, warns that men can find the condition harder to come to terms with than women. "This is a taboo subject among men, who usually cannot bring themselves to say they have cancer of the breast, referring to it as the 'chest' instead."

Cystitis is similarly entrenched in most people's minds as a "woman's problem", but the number of women visiting doctors with the classic symptom of burning pain on passing urine has dropped by 50% to 6m in the past 25 years, partly because they have been well-educated with self-help books and information, says Angela Kilmartin of the Cystitis Information Bureau. However, the number of visits by men to urologists is overtaking those by women.

Cystitis is an inflammation of the bladder. It is more common in women than men because the female urethra - the tube by which urine is passed from the bladder - is short, making it easier for bacteria to enter the bladder. In men, cystitis usually occurs either because of an enlarged prostate gland compressing the urethra, or as a result of contracting a sexually transmitted disease. As with breast cancer, men seem unwilling to acknowledge they even have this ailment. "When men are given the diagnosis of cystitis, they seem to prefer to call it urethritis," says Kilmartin.

Doctors are still divided over the issue of the male menopause, with some arguing that it is an emotionally triggered mid-life crisis, while others insist that it is a physical condition, similar to that suffered by women and, likewise, brought on by changing hormone levels. The fact is that levels of the male hormone testosterone do start to fall between the ages of 45 and 55.

Dr Malcolm Carruthers, who practises in Harley Street, has spent 15 years researching middle-aged male patients and is convinced men suffer a hormonal disturbance every bit as real as the female menopause. "The andropause is the male equivalent of the menopause and there is evidence the condition exists; symptoms include loss of drive in the bedroom and the boardroom, lethargy, depression, irritability and potency problems. These are due to falling levels of free active testosterone (FAT). This is not the total level of testosterone in the body; it is the amount of the hormone available for sex, energy, virility and vitality."

In his study of 1,000 men, total testosterone levels were low in 12%, whereas FAT levels were low in 80% (Carruthers grades a low FAT level at 25%-50% of the normal). According to Carruthers, stress, alcohol and infections in early life all contribute to the male menopause, as may also, he suggests more controversially, a vasectomy, since 25% of those diagnosed with low FAT levels had also been sterilised. Treatment is essentially a type of hormone replacement therapy (HRT) for men - that is, testosterone.

"Patients find difficulty in facing up to a possible male menopause," says Carruthers, "but once I've explained everything - and I refer to it as the 'andropause' because so many men do feel there is a stigma attached to the word menopause - they accept their condition and are relieved that I can help them."

Clearly, there is a challenge for doctors and health workers in how to handle such diagnoses sensitively. Dr Chris Peach, a GP in Battersea, south London, says most men who are diagnosed as suffering from conditions usually associated with women react to the news with bewilderment: "That is why it's so important for men to be aware that these types of illnesses can happen to them," he said.

The bare bones

In Britain, about 10,000 men with osteoporosis fracture their spine every year and 12,000 fracture a hip, a six-fold increase since the 1950s. In America, a survey of 1,000 men by the National Osteoporosis Foundation found that fewer than half knew men suffered brittle bones and fewer than 10% realised it could permanently cripple.

The decline in testosterone that causes reduced bone mass means even a golf swing can cause a serious fracture. Dr Robert Lindsay, the NOF president, warns that of the 100,000 osteoporotic American men who break their hip every year, up to 30% may die within a year.

Breast Cancer in Men

More than 200 men a year in Britain are diagnosed with breast cancer. Every 12 months, 90 men die from a disease which many are not even aware they are at risk from.

Because of widespread ignorance about the disease too many men are seeking help too late.

Survival rates after five years range from around 50 per cent among those diagnosed at an advanced stage, to 85 and 90 percent among malignancies caught early.

Professor Ian Fentiman, professor of surgical oncology at Guy's Hospital, whose specialities include breast cancer says the survival rates among men and women with breast cancer are about the same but that the average length of symptoms before a man goes to see his doctor is about 18 months in men, while for a woman it is one to two months.

Breast Cancer Care operates a freephone advice service for men and women employing specialist counsellors.

A small number of male breast cancers may be linked to genetic inheritance. Smoking, alcohol, obesity and exposure to electromagnetic energy fields have also been suggested, without confirmation.

Up to 95 percent of male breast cancers are first seen by doctors at a stage where they are firm lumps. Other signs can include localised tenderness, discharge, skin ulceration and nipple retraction or inversion.

Treatment is almost identical for men and women. The main procedure is surgery with a mastectomy and, if necessary, removal of the lymph gland. Radiotherapy and chemotherapy may also be offered, and psychological counselling is available too.

For those who catch the disease at an early stage the outlook is good. The greatest danger for men is that they don't realise it could happen to them. If men don't realise that they could get breast cancer they will ignore the symtoms. The longer you leave it, the worse it can be.

Doctors and health campaigners are keen to see more health education to alert men to the dangers. In a report in the latest issue of the British Journal of Surgery, a team at the Mayo Clinic in Minnesota called for more publicity and said better health education was needed to improve the outlook of men with breast cancer.

Men need to be aware that when they get a breast lump it needs to be checked and they must not think they can't get breast cancer. People should not die of ignorance.

Help us help men
Every $20 helps!

Help us help men
Every $20 helps!

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