Tài liệu Men’s Health Third Edition pdf

Template_6x9_Generic.indd
about the book…
Edited by ROGER S KIRBY, The Prostate Centre, London, UK; CULLEY C CARSON III, University of North Carolina
School of Medicine, Chapel Hill, NC, USA; MICHAEL G KIRBY, The Prostate Centre, London, UK; and ALAN WHITE,
Leeds Metropolitan University, Leeds, UK
The Third Edition of Men’s Health provides an authoritative reference source for urologists, andrologists,
general practitioners, and all professionals who diagnose and treat male patients with a variety of male health
problems, such as prostate cancer, male osteoporosis, and testicular cancer. This comprehensive text also
examines new issues regarding some of the less frequently explored areas of men’s health, such as Tourette’s
syndrome, depression, and cosmetic surgery.
New topics in the Third Edition include:
about the editors
ROGER S KIRBY is Consultant Urological Surgeon, Professor of Urology, and Director of The Prostate Centre,
London, UK. He has written 59 books and 320 academic papers, is founding Editor of Prostate Cancer and
Prostatic Diseases, and Associate Editor of the British Journal of Urology International. In 2006 he was awarded
the St Peter’s medal, the highest award in British Urology.
CULLEY C CARSON III is Rhodes Distinguished Professor and Chief of Urology, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA. He trained in urology at the Mayo Clinic Rochester, MN, USA.
Dr. Carson has received several awards, including 2007 Healthcare Heroes and the Neal Award for
editorial writing.
ALAN WHITE is Professor of Men’s Health and Director of the Centre for Men’s Health, Leeds Metropolitan
University, Leeds, UK, and Chair of the Board of Trustees for the Men’s Health Forum. He is the world’s first
Professor of Men’s Health. His research, among others, includes the Scoping Study on Men’s Health and the
Report on the State of Men’s Health across 17 European Countries.
MICHAEL G KIRBY is visiting Professor to the University of Hertfordshire and to The Prostate Centre,
London, UK. He is Editor of Primary Care Cardiovascular and is on the editorial board of many other journals.
Professor Kirby is a member of several NHS Advisory Boards, Fellow of the Royal College of Physicians, and
Associate Member of the British Association of Urological Surgeons.
Printed in India
DU733X
Clinical Medicine

nC nM nY nK
Edited by
Roger S Kirby
Culley C Carson III
Alan White
Michael G Kirby
men’s health
Kirby
•
Carson
•
White
•
Kirby
Third
Edition
Male Viagra and drug treatment for impaired sexual function
• colon and bowel cancers • oesophagitis • men and mental
health, including male depression • peptic ulcer • OAB in
men • testosterone and the metabolic syndrome • Tourettes
Syndrome • ADHD • men and sport related injuries • men
and their body image, including body building/steroid abuse
• cosmetic surgery for men • rehabilitation in widowed men •
Male Viagra and drug treatment for impaired sexual function
• colon and bowel cancers • oesophagitis
men’s
health
Third Edition
• drug treatments for impaired sexual function
• colon and bowel cancers

• esophagitis
• mental health, including male depression
• peptic ulcer
• overactive bladder in men
• testosterone and the metabolic syndrome
• men and sport-related injuries
• men and their body image
• cosmetic surgery for men
• rehabilitation in widowed men
• Tourette’s syndrome
Kirby_978-0415447331.indd 1 12/2/08 2:21:19 PM
Men’s Health

Men’s Health
Third Edition
Edited by
Roger S Kirby MA MD FRCS(Urol) FEBU
Director
The Prostate Centre
London
UK
Culley C Carson III MD
Division of Urology
University of North Carolina at Chapel Hill
Chapel Hill, NC
USA
Alan White PhD RN
Centre for Men’s Health
Faculty of Health
Leeds Metropolitan University

Leeds
UK
and
Michael G Kirby
Visiting Professor
University of Hertfordshire and the Prostate Centre
London
UK
Dedicated to Professor Ken Kirby FRS

vii
List of contributors xi
Foreword xvii
Roger Boyle
Preface xviii
Roger S Kirby, Culley C Carson III, Michael G Kirby, and Alan White
SECTION 1: MEN AND CANCER 1
1. Men and cancer (epidemiology) 3
Alan White
2. Ignorance and uncertainty regarding cancer and cancer genetics in men 17
Clare Moynihan, Robert Huddart
3. Prostate cancer 27
Roger S Kirby
4. Testicular cancer 39
RTD Oliver
5. Bladder cancer 53
David A Swanson, Paul K Hegarty
6. Colorectal cancer 65
John Northover

7. Penile cancer and associated dermatoses 80
Majid Shabbir, Ben Hughes, and Nick Watkin
8. Cutaneous melanoma 88
Keliegh S Culpepper, Phillip H McKiee
Contents
Contents
viii
SECTION 2: CARDIOVASCULAR RISK REDUCTION IN MEN 103
9. Coronary heart disease in men 105
Henry Purcell
10. Raised blood pressure: the biggest cause of premature death and disability in men? 113
Graham A MacGregor, Feng J He
11. Heart failure 120
John GF Cleland, Alison P Coletta, Klaus KA Witte, and Andrew L Clark
12. Lipids and lipid-modifying therapy 153
Moira MB Mungall, Allan Gaw
13. Erectile dysfunction, cardiovascular risk, and the primary care clinician 163
Louis Kuritzky, Martin M Miner
SECTION 3: SEXUAL HEALTH AND MEN 173
14. Risk factors in men with erectile dysfunction 175
Hemant Solomon
15. Evaluation and treatment of male infertility 191
Joseph Dall’Era, Craig S Niederberger, and Randall B Meacham
16. Effects of testosterone replacement therapy on the prostate in the aging male 199
Michael G Kirby, Melanie E Cunningham, and Frances Bunn
17. Novel approaches to male contraception 211
Richard A Anderson
18. Peyronie’s disease: history and medical therapy 223
J Slade Hubbard, Culley C Carson III
19. Hypospadias: uncovering a common problem 239

Hitendra RH Patel and Christopher RJ Woodhouse
20. HIV infection and AIDS 252
Andrew M Moon, John A Bartlett
21. Sexually transmitted infections 273
Katherine M Coyne, Simon E Barton
22. Circumcision 280
Angus HN Whitfield, Hugh N Whitfield
23. Genital piercing 288
William R Anderson, Simon AV Holmes
SECTION 4: MEN AND CHRONIC CONDITIONS 297
24. Osteoporosis in men 299
Lionel S Lim
Contents
ix
25. Overactive bladder in men 314
Karen E Smith, Karl J Kreder
26. Benign prostatic hyperplasia 325
Tom McNicholas, Charlotte Foley
27. Prostatitis and chronic pelvic pain 337
J Curtis Nickel
28. Androgenetic alopecia 352
Desmond Chia Cin Gan, Rodney Sinclair
29. Diabetes mellitus: focus on type 2 diabetes 368
D John Betteridge
SECTION 5: MEN AND THE GASTRO-INTESTINAL SYSTEM 387
30. Esophagitis and peptic ulcer disease 389
Adam Humphries, Sean Preston
SECTION 6: MEN AND MENTAL/EMOTIONAL HEALTH AND TRAUMA 401
31. Men and mental health 403
Alan Pringle

32. Trauma in male health 413
Tatum Tarin, Simon Kimm, Jack W McAninch, and Daniel Rosenstein
33. Men and suicide: assessment and management in a primary care setting 424
Nick Hervey, Dominique LeTouze
34. Alcohol 431
Brian Wells
SECTION 7: MEN AND THEIR LIFESTYLE 443
35. Exercise and health 445
Roy J Shephard
36. Obesity and men’s health 463
David Haslam
37. Smoking and lung cancer 474
Richard Doll
38. Men as risk takers 484
Rod Griffiths
39. Keeping fit: avoiding and diagnosing chronic soft-tissue injuries 489
David Sutherland Muckle
40. Men’s body image 493
Donald R McCreary
Contents
x
SECTION 8: MISCELLANEOUS TOPICS 503
41. Men and help seeking 505
Alan White, Ian Banks
42. Men’s health in primary care: an emerging paradigm of sexual function and
cardiometabolic risk 515
Martin M Miner, Richard Sadovsky
43. The health of gay men 536
Justin Varney
44. Men at work 545

Steven Boorman
Index 551
xi
Richard A Anderson
MD PhD FRCOG
Division of Reproductive and Developmental
Science
University of Edinburgh
Edinburgh, Scotland
UK
William R Anderson MB FRCS(Ed) FRCS(Glas)
Urology Research Fellow
Department of Urology
St Mary’s Hospital
Portsmouth
UK
Ian Banks
Professor of Men’s Health
Leeds Metropolitan University
Leeds
and President
European Men’s Health Forum
London
UK
John A Bartlett
Kilimanjaro Christian Medical Centre
Moshi
Tanzania
and Division of Infectious Diseases
Department of Medicine

Duke University Medical Center
Durham, NC
USA
Simon E Barton BSc MD FRCP(Ed) FRCP
Consultant Physician GUM/HIV
Chelsea & Westminster NHS Foundation Trust
London
UK
D John Betteridge MD PhD
University College London
London
UK
Steven Boorman MBBS MRCGP FFOM FRCP
Director Corporate Responsibility
Chief Medical Adviser
Royal Mail Group
London
UK
Frances Bunn
Faculty of Health and Human Sciences
University of Hertfordshire
Hertfordshire
UK
Culley C Carson III
MD
Division of Urology
University of North Carolina at Chapel Hill
Chapel Hill, NC
USA
List of contributors

Contributors
xii
Sir Richard Doll DM Dsc FRCP FRS
Honorary Member, Clinical Trial Service Unit and
Epidemiological Studies Unit
Nuffield Department of Clinical Medicine
University of Oxford
Oxford
UK
Charlotte Foley
BM BCh MA MRCS
Department of Urology
Barnet and Chase Farm Hospitals NHS Trust
Barnet General Hospital
Barnet
UK
Desmond Chia Chin Gan MBBS BMedSci
Department of Dermatology
St Vincent’s Hospital
Melbourne
Australia
Allan Gaw MD PhD
Director, Clinical Trials Unit
Glasgow Royal Infirmary
Glasgow, Scotland
UK
Rod Griffiths
CBE
Past President
Faculty of Public Health

London
UK
David Haslam MD
General Practitioner
Watton Place Clinic
Watton
Physician in Obesity Medicine
Centre for Obesity Research
Luton & Dunstable Hospital
Luton
and Clinical Director
National Obesity Forum
UK
Feng J He
Blood Pressure Unit
Cardiac and Vascular Sciences
St George’s, University of London
London
UK
Andrew L Clark
University of Hull
Castle Hill Hospital
Kingston-upon-Hull
UK
John GF Cleland
University of Hull
Castle Hill Hospital
Kingston-upon-Hull
UK
Alison P Coletta

Medical Writer
European Journal of Heart Failure
University of Hull
Castle Hill Hospital
Kingston-upon-Hull
UK
Katherine M Coyne
BA MRCP
Specialist Registrar GUM/HIV
Chelsea & Westminster NHS Foundation Trust
London
UK
Keliegh S Culpepper
MD
Harvard Dermatopathology Fellow
Department of Pathology
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA
USA
Melanie E Cunningham
Faculty of Health and Human Sciences
University of Hertfordshire
Hertfordshire
UK
Joseph Dall’Era MD
Division of Urology
School of Medicine
University of Colorado – Denver
Aurora, CO

USA
Contributors
xiii
Michael G Kirby
Visiting Professor
University of Hertfordshire and the Prostate
Centre
London
UK
Roger S Kirby
MA MD FRCS(Urol) FEBU
Director
The Prostate Centre
London
UK
Karl J Kreder MD MBA
Professor and Vice Chair
Department of Urology
University of Iowa
Iowa City, IA
USA
Louis Kuritzky
MD
Family Medicine Residency Program
University of Florida
Gainesville, FL
USA
Dominique LeTouze
Southwark Primary Care Trust
Southwark

UK
Lionel S Lim MBBS MPH FACP FACPM
Assistant Clinical Professor of Medicine
Griffin Hospital
Derby, CT
USA
Graham A MacGregor
Blood Pressure Unit
Cardiac and Vascular Sciences
St George’s, University of London
London
UK
Paul K Hegarty
Department of Urology
University of Texas MD Anderson Cancer Center
Houston, TX
USA
Nick Hervey
South London and Maudsley Hospital
London
UK
Simon AV Holmes MB MS FRCS(Urol)
Consultant Urologist
St Mary’s Hospital
Portsmouth
UK
J Slade Hubbard MD
Division of Urology
University of North Carolina at Chapel Hill
Chapel Hill, NC

USA
Robert Huddart
Institute of Cancer Research
and The Royal Marsden Hospital Trust
The Bob Champion Unit
Sutton
UK
Ben Hughes MBBS FRCS
Clinical Research Fellow in Urology
St George’s Hospital
London
UK
Adam Humphries MBBS BSc MRCP
Department of Histopathology
London Research Institute, Cancer Research
and Department of Gastroenterology
St Mary’s Hospital, Imperial College
Healthcare NHS Trust
London
UK
Simon Kimm MD
Urology Resident
Stanford University
Stanford, CA
USA
Contributors
xiv
Andrew M Moon
Kilimanjaro Christian Medical Centre
Duke University Collaboration

Moshi
Tanzania
Clare Moynihan
Research Associate and Senior Research Fellow
Academic Department of Radiotherapy
Institute of Cancer Research
and The Royal Marsden Hospital Trust
The Bob Champion Unit
Sutton
UK
David Sutherland Muckle
MD FRCS
Consultant Surgeon in Trauma and Orthopaedics
Medical Adviser to FIFA, UEFA, and The FA.
Examiner, Royal College of Surgeons
Edinburgh
and Park View Medical Clinic
Middlesbrough
UK
Moira MB Mungall MB
Clinical Research Fellow
Glasgow Royal Infirmary
Glasgow, Scotland
UK
J Curtis Nickel MD FRCSC
Professor of Urology
Canada Research Chair in Urologic Pain and
Inflammation
Queen’s University
Kingston General Hospital

Kingston, ON
Canada
Craig S Niederberger MD
Department of Urology
University of Chicago at Illinois
Chicago, IL
USA
John Northover MS FRCS
Professor of Intestinal Surgery
Imperial College
London
UK
Jack W McAninch
MD FACS
Professor and Vice Chairman
Department of Urology
University of California
San Francisco General Hospital
San Francisco, CA
USA
Donald R McCreary
PhD
Adjunct Professor of Psychology
York University
Toronto, ON
and Brock University
St Catherines, ON
Canada
Phillip H McKee MD
Director, Division of Dermopathology

Brigham and Women’s Hospital
Boston, MA
USA
Tom McNicholas MB BS FRCS FEBU
Consultant Urological Surgeon
Visiting Professor, University of Hertfordshire
Lister Hospital
Hertfordshire
UK
Randall B Meacham MD
Division of Urology
School of Medicine
University of Colorado – Denver
Aurora, CO
USA
Martin M Miner MD
Co-Director Men’s Health Center
The Miriam Hospital
and Associate Clinical Professor of
Family Medicine
The Warren Alpert School of Medicine
Brown University School of Medicine
Providence, RI
USA
Contributors
xv
Majid Shabbir
MBBS MD FRCS
Higher Surgical Trainee in Urology
St George’s Hospital

London
UK
Roy J Shephard
Faculty of Physical Education and Health
and Department of Public Health Sciences
Faculty of Medicine
Toronto, ON
Canada
Rodney Sinclair
MBBS MD FACD
Professor of Dermatology
University of Melbourne
Director, Department of Dermatology
St Vincent’s Hospital
Melbourne
Australia
Karen E Smith MD
Fellow Associate
Department of Urology
University of Iowa
Iowa City, IA
USA
Hemant Solomon BSc(Hons) MRCP
The Southeastern Heart and Vascular Center
Greensboro, NC
USA
David A Swanson
Department of Urology
University of Texas MD Anderson Cancer Center
Houston, TX

USA
Tatum Tarin
MD
Urology Resident
Stanford University
Stanford, CA
USA
Justin Varney
MBBS FFPH MSc
Assistant Director of Health Improvement
NHS Barking and Dagenham
Barking
UK
RTD Oliver
MD FRCP
Professor Emeritus in Medical Oncology
Institute of Cancer Research
St Barts and The London Medicine School
Queen Mary University of London
London
UK
Hitendra RH Patel
BMSC PhD BM MRCS FRCS(Urol)
Honorary Clinical Lecturer in Urology
Senior Specialist Registrar
Institute of Urology
University College London
London
UK
Sean Preston BSc (Hons) PhD MBBS MRCP

Department of Gastroenterology
Barts and The London NHS Trust
London
UK
Alan Pringle RGN RMN PhD
Lecturer in Mental Health Nursing
School of Nursing
University of Nottingham
Sutton-in-Ashfield
UK
Henry Purcell MB PhD
Senior Fellow in Cardiology
Royal Brompton Hospital
London
UK
Daniel Rosenstein MD FACS FRCSC(Urol)
Associate Chief, Division of Urology
Santa Clara Valley Medical Center
and Clinical Instructor
Stanford University Department of Urology
Palo Alto, CA
USA
Richard Sadovsky
MD
Associate Professor of Family Practice
State University of New York
Health Science Center at Brooklyn
Brooklyn, NY
USA
Contributors

xvi
Hugh N Whitfield
FRCS
London
UK
Klaus KA Witte
MB MRCP
Specialist Registrar and Lecturer in Cardiology
Leeds General Infirmary
and Department of Cardiology
University of Hull
Castle Hill Hospital
Kingston-upon-Hull
UK
Christopher RJ Woodhouse MB FRCS FEBU
Professor of Adolescent Urology
The Institute of Urology
and Honorary Consultant Urologist
The Hospital for Children
London
UK
Nick Watkin
MA MChir FRCS(Urol)
Consultant Urological Surgeon
Department of Urology
St George’s Hospital
London
UK
Brian Wells
FRCPsych

Consultant Psychiatrist
and Director
Leading Health Care International (LHCI)
London
UK
Alan White PhD RN
Centre for Men’s Health
Faculty of Health
Leeds Metropolitan University
Leeds
UK
Angus HN Whitfield
Reading Hospital
Reading
UK
xvii
Life expectancy continues to extend, but inequitably.
Women live longer than men; richer men live
longer than their counterparts who are less well off.
In developed nations, mortality rates from the
major killers are falling and the pattern of disease
is changing, so that, in general, there are better
outcomes and more long-term survivors.
Attitudes to health between the sexes vary, as
does their willingness to seek medical help. Women
tend to seek help earlier and are more likely to
confide in friends and relatives, whereas men stick
it out, keep mum and hope for the best.
Why should these differences remain prominent
when so much more can be done to alter risk and

improve outcomes? Should the medical profession
be more proactive in seeking out the younger and
middle-aged men in order to help them confront
their demons? Should the screening programs
currently offered to women, such as breast and
cervical screening, be developed for similar key
conditions in men? Should men be offered advice
and lifestyle interventions in a more proactive
fashion?
Many questions remain unanswered, but clearly
an important first step is to ensure that medical and
other health professionals are fully educated in the
specific issues relating to men’s health. This third
edition of Men’s Health provides a commendable
step in that direction, covering specific conditions
as well as the important issues of lifestyle and well-
being.
Roger Boyle
CBE
November 2008
Foreword
xviii
Ten years ago, as we put together the first edition of
Men’s Health, we asked an important question:
‘Why do men die on average five years younger than
women?’ A decade later, although we now have at
least a partial answer, namely that men look after
themselves less well than women, the so-called gen-
der gap still persists. The key issue then for
readers of the third edition of this book is what

can be done to narrow this gap, thereby allowing
men to live longer and healthier lives. This is
precisely the problem that we have asked each
of our authors to address. Accordingly, the third
edition of this book provides practical information
that will help physicians to close the gap.
All three editions of Men’s Health have been
inspired by, and dedicated to, the memory of
the father of two of the editors, namely Professor
Ken Kirby
FRS, who died prematurely from heart dis-
ease in 1967 aged 49. Unfortunately, middle-aged
men continue to suffer sudden, and often fatal,
cardiac events, even though our knowledge about
the ways and means of reducing cardiovascular risk
has increased in leaps and bounds. The problem lies
mainly in the difficulty in persuading men to make
the necessary modifications in their lifestyle that
can dramatically reduce their cardiovascular risk.
Their current attitude towards their health is ‘If it
ain’t broke don’t fix it’. Somehow we have to effect
a sea-change in their attitude to a more pro-active ‘If
you look after it, it doesn’t break’ mentality. Unfor-
tunately, if anything, the situation has deteriorated
recently with an ever-increasing incidence of
obesity, diabetes, and hypertension, both in the
developed and under-developed world. Although
the number of men who smoke has fallen in the
United States and many European countries, sadly
the smoking habit in men continues to rise in

developing countries, with an inevitable increase
in lung cancer deaths. Clearly there is still much
to be done.
The third edition of Men’s Health has been
extensively revised and rewritten, with many new
chapters. In particular, each of our authors has
addressed the problem of the gender gap, especially
in terms of cancer care and cardiovascular disease.
The book is aimed not only at primary care practi-
tioners, who need to encourage their male patients
to visit them more often and to embrace preventa-
tive strategies for their health, but also at specialists,
who too often focus too narrowly on their own areas
of expertise, ignoring other potentially remedial
problems, such as central obesity and unhealthy
lifestyles, rather than tackling them pro-actively.
We hope most sincerely that this new edition of our
book will help to narrow the ‘gender gap’ and pro-
actively prevent some of the premature deaths and
illnesses afflicting men that tragically affect so many
families, with such long-lasting negative impact.
Roger S Kirby, Culley Carson,
Michael G Kirby, and Alan White
October 2008
Preface
SECTION 1
Men and cancer

3
Introduction

The new Cancer Reform Strategy for the UK has
specifically noted that of the 10 commonest cancers
that affect both men and women, age standardized
mortality rates are in every case higher in men.
1

A recent expert symposium on men and cancer
highlighted that, though there were assumptions as
to why this may be the case, it was not yet clear as
to the exact mechanisms and that there was a need
for more research into how sex impacts on the risk
of developing and dying from cancer.
2
This chapter
outlines the scale of the issues facing men and
some of the possible causes of their increased
susceptibility.
The significance of cancer with regard to men ’ s
generally high rate of premature death has changed
over the past 30 years. The incidence rate for all
cancers (excluding non-malignant skin cancer)
for Great Britain has risen from 353.7 per 100 000
in 1975 to 408.2 per 100 000 in 2004 ( Fig. 1.1 );
however, the overall mortality has dropped from
284.1 per 100 000 in 1976 to 215.9 per 100 000
in 2005 ( Fig. 1.2 ),
3,4
suggesting that, though the
overall number has increased, the advances in
treatment have resulted in more people surviving

their cancer.
Prostate cancer
The rising trend in cancer incidence rates for men
can in part be attributed to the aging population
and the increasing diagnosis of prostate cancer,
which has risen from 35.2 per 100 000 in 1975 to
97.9 per 100 000 in 2004 ( Fig. 1.3 ).
5
Whilst the
death rate has risen it is predominately in the over-
85-year-olds ( Fig. 1.4 ) and therefore it has not
overly affected the overall falling cancer mortality
trend.
Burden of cancer as a cause
of mortality
In 2004 there were 71 878 male deaths from cancer
in England and Wales and 66 576 female deaths
from cancer, which account for 29.5 % of total
male mortality and 24.7 % of total female mortality
(calculated from figures produced by the Office for
National Statistics).
6
Nevertheless, when the bur-
den of death is calculated for different age groups
(see Fig. 1.5 ) it can be seen that cancer does tend
to account for a greater proportion of younger female
deaths than it does for men.
When the rate ratios of male to female deaths
are calculated ( Table 1.1 ), it is seen that there is a
slightly higher rate of death for men (with a male:

female ratio of 1.14) across all ages, but that this
drops to about parity in the 15 – 64 year age range
before rising to nearly a 50 % higher rate of death
in men over the age of 65 years. Predominately
the cancer deaths that women succumb to in
their early years are those related to the breast and
CHAPTER 1
Men and cancer (epidemiology)
Alan White
Men’s health
4
Figure 1.2. Age-standardized (European) mortality, all cancers, by sex, Great Britain, 1976 – 2005.
4

0
50
100
150
200
250
300
350
1976
1978
1980
1982
1984
1986
1988
1990

1992
1994
1996
1998
2000
2002
2004
Year of death
Rate per 100 000 population
Males Females Total
Figure 1.1. Age-standardized (European) incidence rates for all cancers excluding non-malignant skin cancers,
by sex, Great Britain, 1975 – 2004.
3

0
50
100
150
200
250
300
350
400
450
1975
1977
1979
1981
1983
1985

1987
1989
1991
1993
1995
1997
1999
2001
2003
Year of diagnosis
Rate per 100 000 population
Males Females Total
Figure 1.3. Age-standardized
(European) incidence and
mortality rates, prostate
cancer, males, Great Britain,
1975 – 2005.
5

0
20
40
60
80
100
120
1975
1977
1979
1981

1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
Year of diagnosis or death
Rate per 100 000 males
Incidence Mortality
Men and cancer (epidemiology)
5
When the incidence data are considered
( Table 1.2 ),
7
it can be seen that there are more
women registered with cancer in England and Wales
in the 15 – 64 year age range (with a male:female
ratio of 0.83), but again when breast cancer and
the cancers relating to genital organs are removed
from the equation a greater number of men are
seen to be at risk of the non-sex-specific cancers.
This tendency is seen across the cancers listed
in Table 1.2 , with the exception of skin cancer,
where more women are registered, but as can be

seen from Table 1.1 , more men actually die from
the condition.
genital organs (27.6 % overall and over 50 % in the
35 – 44 year age range) (calculated from figures
produced by the Office for National Statistics).
6

For men there are no significant numbers of deaths
that can be attributed to a sex-specific cause, such
that if the rate ratios are calculated when breast
cancer and those cancers that can be seen to be
unique to men or women are excluded a different
picture emerges, with over 60 % more men in the
15 – 64 year age range succumbing to cancers that
should be affecting men and women equally. This
increased risk is seen across a broad range of
principal cancers.
Figure 1.5. Cancer deaths as a proportion of total deaths by age and by sex, England and Wales, 2004.
6

0.0
10.0
20.0
30.0
40.0
50.0
60.0
All ages
1–4
<1

10–14
5–9
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85–89
90–94
≥95
(%)
Males
Females
Figure 1.4. Age-specific
mortality rates, prostate cancer,
males, UK, 1971 – 2005.
5

0
200
400

600
800
1000
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
Year of death
Rate per 100 000 males
45–54 years
55–64 years 65–74 years 75–84 years ≥85 years
Men’s health
6
Austria (2002), Brazil (2000), Denmark (1999),
Estonia (2002), Hungary (2002), Japan (2002),
Portugal (2002), Spain (2001), Sweden (2001),

Thailand (2000), the UK (2002), and the USA
(2000).
The median rate ratio was calculated by age from
the 14 countries for all cancers and for cancers
excluding the available data on breast cancer and
genital cancer. The picture for all cancers showed
that the age groups 25 – 34 years and 35 – 44 years
had a median rate ratio below 1, indicating that
more women were dying, but when breast
cancer and the cancers relating to genitalia were
omitted ( Figure 1.7 ) then the median rate ratio
rose to 1.4 in these age groups and was higher in
other age groups.
What seems to be emerging is that men are
at greater risk of developing and dying from those
cancers that should be seen to affect men and
women equally.
The increased risk of premature male death is
seen clearly when the years of life lost and the
mean age of death are considered ( Table 1.3 ),
9
with
112 000 years of life being lost by men for the port-
folio of cancers as opposed to 73 000 years of life
being lost by women in the age bracket 15 – 64 years,
and the median age of death being 71 years for men
and 74 for women.
A development of this UK analysis was
undertaken by White in 2007 for the Congresso
Nacional de Epidemiologia, which focused on ‘An

Epidemiological Perspective of Men ’ s Health ’
as part of the Portuguese Presidency of the
European Union ( Fig. 1.6 ).
10
An examination of
the data for a broad span of countries held on
the World Health Organization Mortality Database
explored if there were similarities relating to
the increased risk of the non sex-specific cancers.
The countries from which data were examined
were Argentina (data from 2001), Australia (2001),
Table 1.1 . Rate ratio of male to female deaths, England and Wales, 2004
6

ICD-10 code Site description
Rate ratios, male to female
All ages 15 – 64 years ≥ 65 years
C00 – C97 All cancers 1.14 1.03 1.49
C00 – C97 excluding C50,
C51 – C58, C60 – C63
All cancers excluding breast and
sex-specific cancers
1.37 1.61 1.65
C15 Esophagus 1.90 3.34 2.06
C16 Stomach 1.68 1.90 2.08
C18 – C21 Colon and rectum 1.20 1.55 1.43
C22 Liver 1.50 1.93 1.73
C25 Pancreas 0.97 1.26 1.14
C33 – C34 Lung 1.53 1.45 1.97
C43 Malignant melanoma of skin 1.31 1.34 1.61

C64 Kidney 1.65 2.15 1.89
C67 Bladder 2.02 2.36 2.53
C71 Brain 1.55 1.69 1.76
C82 – C85 Non-Hodgkin ’ s lymphoma 1.16 1.68 1.29
C90 Multiple myeloma 1.17 1.45 1.43
C91 – C95 Leukemia 1.30 1.51 1.59