UK: In race to treat cancer, are men sidelined by the NHS?

prostate cancerCancer treatment in Scotland appears to favour women over men, who face longer waits and delays in treatment, a leading doctor has warned.

Figures on cancer waiting times show that 88.2 per cent of breast-cancer patients are starting treatment within the two-month target from urgent referral by their doctor. But waiting-time for targets in urological cancers, including prostate and testicular cancers, hit only 67.5 per cent.

Dr David Love, joint chairman of the British Medical Association's GPs committee, said men might be the unintended victims of high-profile campaigns which have lobbied successfully to improve breast-cancer care.

The gender "bias" is most marked in the Borders. Up to 100 per cent of breast-cancer patients start treatment within two months, but for urological cancers, achievement of the target falls to a low of 54.5 per cent.

Dr Love, a GP in Peebles, said: "When I looked at the cancer waiting figures, there seemed quite a stark difference between male and female cancers. Some areas had 100 per cent with breast cancer, but at the same time 50 to 60 per cent with urological cancers.

"I think it's related to the fact that where you have got very effective pressure groups and charities who are pushing for better treatment for cancer for women, you are seeing better results.

"Urological cancers don't have the same pressure groups working to push for better treatment, and where they do it is less well-known about."

He added: "This suggests performance is being driven by the presence or absence of a pressure group. I don't think that's right. It concerns me that there is no group pushing for men's health in the same way."

Charities including Breakthrough Breast Cancer and Breast Cancer Care have led the way in promoting awareness of the disease, boosting research and improving treatment for women. Charities campaigning for men's cancers exist, but have a much lower profile and attract less funding.

Dr Love said that health boards and the Executive had the power to change capacity to treat patients, and appeared to be affected by the strong voice of the breast-cancer charities.

"It is the boards and the health department that determine capacity," he said. "The way to see more patients more quickly and treat them faster is if you have the capacity to do that.

"The reason you have waits is because of lack of capacity and that is where we get the differences between cancers. But performance should be delivered irrespective of the pressure-group consistency.

"On the evidence of these waiting-time figures, it would seem clear spending priorities for cancer treatment favour women over men."

Dr Love admitted men were not good at seeking help for medical problems, but said when they did come forward and seek help, they were not treated as quickly as other groups.

The Orchid Cancer Appeal, which campaigns for research into prostate and testicular cancer, is one of the few charities which focus on male cancers.

Angus Somerville, its chief executive, said three times the amount of money was spent on research into breast cancer as against prostate cancer, despite the fact that many unknowns remained about the diagnosis and treatment of the male disease.

"We do not yet have the Herceptin of prostate cancer and as far as I know we are quite a long way away from that," he said. "The breast cancer charities are on a much bigger scale, have a much louder voice, and the result is that breast cancer is one of those issues at the front of everyone's minds. Men's cancers are about ten years behind."

Mr Somerville said men with prostate cancer reported a very different experience during treatment than women with breast cancer and were offered less support and given less information.

Dr Ian Banks, president of the Men's Health Forum, said:

"From an early age men are dissuaded from using the health service, while women are encouraged. This means they are less likely to form these pressure groups which have been so successful for women's cancers. They have become a great political force."

Leslie Moffat, a urologist in Aberdeen and spokesman for The Prostate Cancer Charity, said: "With prostate cancer, it is sometimes better not to rush into radical treatment, unlike other cancers where speed is usually key. Some prostate cancers are slow-growing and will not cause a problem to the man, so it is better to wait."

But Dr Moffat said where the necessary treatment was clear, men should not wait.

Liz Carroll, head of clinical services at Breast Cancer Care, said: "Part of the problem might be that men are less likely than women to go to their GP with a problem. But once they do, they should not have to wait any longer than they have to."

Shona Robison, SNP health spokeswoman, said: "Targets should be met for everyone, regardless of where they live, what cancer they have or whether they are male or female."

An Executive spokeswoman said: "Excellent progress has been made in specific cancer services. It is recognised, however, that not all cancers present themselves in the same way and some are more difficult to detect and treat. We have invested £150million in cancer services."

'Great service, from moment we knew'

WHEN Christine Kelly was diagnosed with breast cancer, she had countless questions she wanted answers to.

What kind of treatment could she expect, what would happen with work, how could she break the news to her two young children?

But from the outset, she could not have asked for better care from the NHS, she said.

The 46-year-old, from Portobello, Edinburgh, found a lump in her breast in August 2001.

She went to see her doctor and was quickly diagnosed. Treatment began just three weeks later.

"As soon as I was diagnosed I was given a breast cancer nurse," she said. "She answered every question under the sun that we could think of at the time and I had her contact details so I could call her any time with other questions.

"She gave me advice on how I could break the news to my children - which was really helpful."

When Mrs Kelly went in for treatment at the Western General Hospital in Edinburgh she had her own private room so that her family could spend as much time there as they wanted.

She said all the rooms for breast patients were no bigger than two or three beds, so they had plenty of privacy.

"On the night before my surgery I was offered a glass of wine. They said it was therapeutic and it did help me relax. All the staff were lovely and could not have been more helpful," she said.

Mrs Kelly, who lives with husband Peter and children Ashleigh, 17, and Nathan, 11, said the facilities for breast cancer patients were "fantastic".

They had access to special baths, and women who had breast cancer in the past came to speak to her about their experiences.

She was given a full run-down of what her treatment would involve, and wigs and scarves were available if she wanted.

"I had never been ill before and did not know what to expect," she said, "but from reading some stories I knew that it was sometimes not good.

"But I could not criticise the treatment I received. If I wanted any help it was there. I could not have paid for it and got a better service."

Mrs Kelly is now clear of cancer and helps raise awareness with charity Breakthrough Breast Cancer.

"I really want to raise awareness and tell people it is not so bad and you can carry on with your life," she said.

Mrs Kelly said she thought it was right that charities paid for the extras while NHS focused on core care of cancer patients.

'Prostate disease is one nobody discusses'

WHEN Jim Steel was diagnosed with prostate cancer it came as a big shock. The 69-year-old had a biopsy taken after his wife persuaded him to see his GP for an enlarged prostate in 2002. The tests came back negative for cancer.

Then in January 2003 he had a PSA (prostate specific antigen) test - a marker for disease - which showed his PSA level was slightly above normal.

A second test in September found his PSA level was raised further.

But after this Mr Steel, from Irvine, Ayrshire, found that appointments for a second biopsy were repeatedly changed and postponed.

Finally, in May 2004, he had a second biopsy. This found that he had an aggressive type of prostate cancer that had spread slightly outside his prostate.

But Mr Steel, who was finally treated at Ayr Hospital, said he was given no explanation as to why a biopsy originally scheduled for May 2003 was not done for a year.

He said initially it was delayed due to a holiday he had already booked and then because he needed a hip replacement operation. But after this, he has no idea why it took so long.

"By the time I had the biopsy it was found that I had an aggressive cancer and that it had spread outside the prostate.

"When that happens it limits your treatment options - you can't have surgery. I started hormone treatment straight away."

Mr Steel, who runs a prostate cancer support group in Ayrshire and Arran, said at the time he thought the doctors knew best and did not question the delays.

He added: "Afterwards I was worried. The anger follows, but it was much later when I became more aware of what was happening.

"It is possible that if I had had the biopsy earlier the cancer would not have spread."

Mr Steel has now had hi-tech radiation treatment to rid him of cancer. He admitted that a lot of delays with male cancers were "of men's own making".

But he said the NHS had to improve its communication so patients were not lost in the system.

"There are a lot of men in a worse position than me and I get angry when I hear their stories and about the delays," said Mr Steel.

"Prostate cancer is a neglected cancer.

"There is a lack of publicity, a lack of awareness," he went on. "You don't hear politicians going on about it like you do with other cancers.

"You don't go down the supermarket and see that they have just had some charity event in aid of prostate cancer."

source - Scotsman News


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