By Tom Geoghegan
BBC News Magazine
When doctors first examined former footballer John Hartson last week, he was already in the advanced stages of testicular cancer, which had spread to his brain and lungs. Why do men commonly get medical help later than women?
John Hartson went into Swansea's Singleton Hospital a week ago and doctors quickly established that he had testicular cancer which had spread to other parts of his body. Within days he'd had emergency brain surgery.
Hartson remains in a critical condition
It's not clear whether the former Celtic and West Ham hero had ignored warning signs - sometimes testicular cancer has no symptoms.
Cycling legend Lance Armstrong, who has sent Hartson his best wishes, admitted he delayed going to a doctor for months before he was given a similar diagnosis in 1996.
A survey last month for the Everyman Male Cancer Campaign suggested that nearly twice as many men as women had not visited their GP in the past year.
Evidence suggests fewer men go to dentists or ask the pharmacist for advice and information, or attend contraception clinics, although men are more likely to end up in hospital because they delay for so long.
Even male cancer helplines are used more by women, speaking on behalf of partners, fathers or sons. And the fact that more women get skin cancer than men but more men die from it, indicates how late men are going to doctors.
Men are slowly getting better at it, says Mike Shallcross, associate editor of Men's Health magazine, but the contrast is made between men's attitude to testicular lumps and women checking their breasts for potential tumours.
Martin Carter waited nine months to check his swollen testicle
'I thought it was something sexual, something I'd caught, and that made it even harder to talk about it.
'Also, I didn't know where to start. I was young and had hardly been to my doctor and when I had it was with a parent. That lack of experience meant I didn't know where to start when it came to seeing my GP.
'When I finally got help I felt ashamed that I had left it so long. It would have saved myself and my family so much worry and pain.
'My family were really upset and felt so guilty that I had felt as if I couldn't talk to them.'
"There's that fear when you find a lump on your testicle of thinking 'If I go to the doctor he'll just lop it off', which is the standard treatment, but you can get by perfectly with the one. But in the vast majority of cases, it's not cancer at all and you've done the right thing and got a weight off your mind."
This kind of comparison can be misleading, however, because women need to be more vigilant, he says, Breast cancer is much more common, with about 45,000 new cases a year compared with 2,000 new cases of testicular cancer, which makes up only 1-2% of male cancers and has a very high survival rate.
"Men could learn from women about attitudes to health. I would characterise it as the way they treat their cars. Women drive very carefully and make sure they take it into the garage at the right time but men just put their foot down until it's knackered."
Embarrassment and inexperience were the reason Martin Carter, 37, waited nine months to get his testicle checked after it became swollen and hard.
He finally got it seen when it swelled to four times its normal size and he had severe back pain and was losing weight. By then the cancer had spread to his lungs and abdomen and was pushing against his spine.
"I was only 20 and quite shy," he says. "Even though I was close to my family and friends, I just felt too embarrassed to tell anyone. I felt awkward.
MOST COMMON MALE CANCERS
1: Prostate - 24%
2: Lung - 15%
3: Colorectal - 14%
4: Bladder - 5%
5: Non-Hodgkin Lymphoma - 4%
Testicular - 1-2% (below top 10)
Source: Cancer Research UK
"I thought it was something sexual, something I'd caught, and that made it even harder to talk about it. Back then testicular cancer wasn't so well known, there were no awareness campaigns like now.
"Also, I didn't know where to start. I was young and had hardly been to my doctor and when I had been, it was with a parent. That lack of experience meant I didn't know where to start when it came to seeing my GP."
He had his testicle removed, along with the tumours in his lungs and abdomen, and underwent chemotherapy. The treatment was successful but 14 years later, in 2006, his remaining testicle showed signs of cancer.
He got it checked straight away and was told the cancer had returned. But because he acted immediately it hadn't spread anywhere else and he only needed to have the testicle removed.
Martin's experience underlines the cultural reasons behind the gender divide in the self-diagnosis of cancer, says Professor Colin Cooper, head of the Everyman Centre, Europe's first research centre dedicated to male cancer.
FAMOUS MEN WITH CANCER
Robert De Niro (above) - prostate
Former US state secretary Colin Powell - prostate
Comedian Bob Monkhouse - prostate (died in 2003 and appeared posthumously in a TV cancer campaign)
Footballer Alan Stubbs - testicular
Lance Armstrong - testicular
"Historically women have always been the custodians of health in the family," he says. "They have cervical screening and breast screening and they take the kids to the GP. But men don't do any of that and tend to be much more reluctant to go when they have symptoms."
It could also be argued that women use the NHS at an earlier age, because of contraception or child birth, and they are generally more in tune with changes in their bodies.
Cancer survival rates in the UK are among the lowest in Europe because the British - both sexes - are for some reason less inclined to go to a doctor and cancer is diagnosed late, says the professor.
Celebrity Jade Goody, who died earlier this year after cervical cancer spread, ignored a letter saying a cervical smear test had indicated abnormalities. But generally women are better than men at acting.
"Men tend not to talk about health," he says. "Eight years ago we did a survey which found that men like to talk about sport, women, cars. Even politics is more popular than health issues. It has slightly opened up since but there's still a problem."
That's why men are going to doctors with very advanced cancer, he says, and John Hartson's survival prospects, although still quite good at about 60:40, would have been 99:1 had he been diagnosed earlier.
Men have a reluctance to ask for help or admit they have a problem about anything, says Peter Baker of Men's Health Forum, but basing primary health care around office opening hours hardly helps men who are in full-time work.
However, testicular cancer is not the major issue facing men because it's rare and the clear-up rate is high.
"Campaigns have worked because doctors are seeing testicular tumours at an earlier stage. If I was to pick one issue above all others, I would say obesity and we should do much more about alerting men to the dangers of being overweight."
Men are generally in poorer health, he says, with a worse diet. They are more likely to smoke and be alcoholics. They do more physical activity but the majority don't do enough to make any difference to their health.
"Taking risks and thinking nothing bad will happen is even seen as part and parcel of being a man," he says.
Health education should equip men with an understanding of what taking these risks means and how it affects their health, but it needs to be done in a humorous way to have any impact.
This should entail going to the workplace, the pub, the sports venues, and using humour to break down barriers, says Mr Baker.
A recent successful campaign was based on a Haynes car repair manual, with a man's body illustrated as a car engine.
Additional reporting by Denise Winterman
Here is a selection of your comments.
I feel it is sadly true that men, particularly young men, feel that they are invincible and do not seek medical attention until symptoms become almost life threatening. However this culture is changing and men are more willing to discuss health issues- if only the information is actually out there. Unlike many of the other cancers you have mentioned in this article, testicular cancer is one of the few that can be cured IF, caught early enough. More attention should be paid toward the simple act of checking yourself and knowing what feels right for you - this routine could be what saves your life.
Anna Haywood, Buckinghamshire
I have had testicular cancer and luckily I caught it early. I discovered it whilst showering one morning. However, I was moving country at the time and only decided to do something about it once I had moved. This was about two months from initial discovery to treatment. I went through a phase before diagnosis of shrugging it off, but as I am relatively health conscious, I decided I had to do something about it. Its only having had a serious illness that you become sensitive to them. I now have annual blood checks.
Colin Larcombe, Orléans, France
I work for the NHS in Health Improvement and lead on men's health. I totally agree with a number of the comments above; particularly access times and attitudes of GPs. I hear these comments all the time from large groups of men who I deliver men's health awareness sessions to (using humour as an approach!). New extended hours and 8am-8pm 7 days a week surgeries are available now where anyone can simply walk in and see a GP. We are promoting these as much as possible at the moment alongside self checking awareness. Men need to keep pushing GPs or ask for a second opinion, and yes some work may need to be done with GP's but for every difficult GP, you have another fantastic one who champions the cause so it's not good to generalise.
Richie Andrew, Middlesbrough/Redcar and Cleveland
I agree with the 'doctor's condescending attitude' theme to some of these posts.
I have experienced this on a couple of occasions at our local surgery (seen by different doctors). I went because I was concerned by a skin/chest irritation & I wondered if it was a possible cancer issue. I had tried to find good NHS info about male breast cancer on their websites, but it's all centred around female breast cancer. The doctor was very dismissive and said that male breast cancer was very rare - how was I meant to know that? She couldn't say what it was and told me to try changing washing detergent. Is it any wonder that we (men) don't take our symptoms to the doctor until it's very serious!
As I hit my 40s I requested a "well man" check from my GP. Duly arranged I turned up and I was weighed and my blood pressure taken.
"Was that it?"
"Well, do you have any questions?"
No cholesterol checks, no lifestyle questionnaire, no liver function test, no testicle or prostate exam, nothing. I could have done it at home myself. A complete waste of time and money. When I worked in Japan EVERY public sector worker had a full work up every year - admittedly this was overkill - barium meals and x-rays - but some half-way house is surely needed.
Frankly, if you're a male of working age, doctors also assume there can be little wrong with you. I asked for a general check-up when I reached 40, and as well getting a slightly frosty response, was asked "well, do YOU think there's anything wrong?" It's not embarrassment, it's being made to feel you're wasting the time of NHS staff.
While it's true that us men often ignore our health problems, my experience is that most doctors don't take my health seriously enough. I have suffered health problems for over four years, but it took three years of trying, and four GPs, till I was referred to hospital specialists - where they discovered I had chlamydia, intestinal parasites, and a potentially serious lung problem! The first GP, when I told her on the phone I had just had a urinary tract infection while away in Wales, and had been advised by the doctor there to make an urgent appointment on my return, told me that men do not get UTIs (by implication accusing me of lying), and refused to see me. This meant I continued to have chlamydia for three more years and could potentially have infected hundreds of people -- fortunately I hadn't! Yet most women I know are repeatedly offered tests for STIs.
Rupert Taylor, Bristol, England
This article indicates one of the many problems men face in life generally. It's full of negatives; it's always our fault! Why don't women take a greater part in parliamentary politics? Because we (men) don't encourage them enough. Why don't men go to the doctor? Because the NHS focuses so much on women, because men are not brought up with health issues like women are, because your local health centre is like a women's centre, because men are under pressure as bread winners not to take time off for the doc? No, because men are bad, slow, unprepared etc. A more positive attitude and a little less blame is what's called for.
John Connolly, Northampton
I live in Ealing and my local 'health' centre is so over-subscribed they won't give you an appointment. You're supposed to ring up on the day and they'll fit you in. What good is that to me? I work full-time and would never go to the doctor with a cold or flu. As a child I reacted to the whooping cough jab and on the advice of my GP wasn't vaccinated against measles. Recently my local 'health' centre refused to vaccinate me as I was too old. I'm 28. In the end I got the jab at my previous GP practice in Northants. I love Britain but why are so many 'services' substandard?
James, Ealing, London
Lots of men don't visit the doctor because they shrug off their symptoms either as bravado or just because it doesn't seem significant. Funny really because the stereotype is that we get man-flu and think things are worse than they really are so you'd expect us to be going more than women. The other reason could be that we don't want to "put doctors out" and take valuable time away from those perceived to be more sick than us. This is exacerbated by overworked GPs wanting to get through the daily surgery and giving an impression of hurrying us through. You might feel you've put out a GP by seeing them with what you consider trivial symptoms and not go back again.
Johnny Maelstrom, Surbiton
Amongst other reasons I am sure there is one BIG reason why men dont report illness such as testicular cancer or indeed prostrate cancer: they are often unaware of what signs to look for (unlike breast cancer where there is clear info on what to look for and how to go about it). The answer to this might well include info such as has been given recently on the TV about strokes and/or popular TV programmes such as Coronation Street or EastEnders including such info in their storylines.
Pete Lawton, Birmingham UK
I am a diabetic. In my recent visits to my GP, I found him to be patronising and demeaning. I will never be going back to the same GP and will be asking for a different GP at the surgery. Such behaviour can drive patients away. There must be strict rules about how GPs can speak to their patients as this can drive patients away and affect patients' health.
Ashish Kulkarni, Stirling, Stirlingshire
I think there are two measures that could be considered to improve the statistics:
1. Make medical self-observation part of school education. Some basic medical knowledge and the ability to tell signs of certain illnesses is just as important as basic maths.
2. It would be helpful to provide an annual health checkup for every person. It does not need to be high tech, just a 10 minute appointment with your GP to do some basic checks and have a chat. But I suppose this would already put too much strain on the NHS.
Holger, Bristol, UK
It should be compulsory for men and women to have regular checks at the doctors for cancer. More and more often, we hear of people being diagnosed too late, why aren't we all allowed the opportunity to be regularly checked by our GP? Maybe even full health checks on a yearly basis. This would mean more GPs or them having to work weekends, but what price a human life?
Rick Harrison, Doncaster
GP opening hours are a major issue - I work away from home in hotels 5 days a week and my GP doesn't open on a Saturday. Even if I can work locally, the earliest appointment is 0830 so I would still not start the commute to work until 9. Us men are notoriously lazy at making an effort when it is needed so make healthcare more accessible and reduce the effort required!