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Is Movember a misguided attempt to do good for middle-aged men?

There are no short cuts to improving your health and no magic bullets. Routine handfuls of vitamins will do you no good. In fact, randomised trials have repeatedly shown that people are actually worse…

Men would be better off if Movember focussed more on health interventions we know to be effective. Anthony Danielle

There are no short cuts to improving your health and no magic bullets. Routine handfuls of vitamins will do you no good. In fact, randomised trials have repeatedly shown that people are actually worse off from popping vitamins.

Indeed, there’s no avoiding the fact that eating a wide variety of good food (lots of colours, more vegetables and fruit than dairy and meat) but not too much, keeping physically active, stopping smoking and making sure you don’t drink too much alcohol, are best. Boring, isn’t it?

Still, it’s the best way to avoid illness and disease. And of these, what scares people the most is cancer.

Two gentlemen in the waiting room of a practice I was working at were overheard by our reception staff chatting about a third, who had recently died.

“What did old Bill die of, then?” one asked. “I didn’t even know he was sick.”

“I don’t rightly know,” was the reply. “But I don’t think it was anything serious."

Behind the apparent ludicrousness of this conversation is the implicit dread of cancer. Bill probably didn’t die of it. We would prefer to die of almost anything else.

The gender-specific cancer affecting women is breast cancer (although a very small number of men also get it). It runs neck and neck with lung cancer in causing more deaths and harm to women than any other. Luckily, we can do something about it because randomised trials have shown breast cancer can be detected by screening at the right age. And early detection and prompt treatment reduces the number of deaths from the disease.

But what about men? Is there something we can do to help them? The obvious contender is prostate cancer (women don’t have a prostate). It’s very common, it’s being diagnosed at increasingly greater rates, and causes a lot of early deaths (and harm).

So promoting screening for it is attractive. And it provides a nice symmetry. Women go off for their breast cancer screening at age 50, and their menfolk follow soon after. Of course, we know that men are much more reluctant to appear before the doctor, so we need something to encourage them. A sort of blokey message, “garn mate, y’know whatcha gotta do.”

Hence Movember. The trouble is we don’t know that screening for prostate cancer works.

That’s right. There’s huge controversy about it. There are advocates for screening (often those doctors who treat prostate cancer) and those who discourage it (especially public health and primary-care doctors).

The huge prostate cancer screening trials, equivalent to those of breast cancer from 20 or 30 years before, have only been published in the last year or two. And the results are ambiguous.

Some find a small benefit, and others none. It’s such a fine call that the evidence has done little to resolve the issue. Rather, experts are bunkering down to their prior beliefs, with each point of view finding some comfort in their interpretation of the trial data (which, it has to be admitted, is complicated and difficult to sort through).

All this means that one half of Movember, which aims to increase men’s awareness of prostate cancer and male mental health, is deeply flawed. Sadly, the campaign doesn’t focus on preventive activities we know to be particularly effective – stopping smoking, reducing alcohol consumption down from damaging levels, and doing more physical activity (although its website does mention them). Health promotion in this area is often unexciting and difficult, but we know it pays dividends in saved lives and avoided misery.

Instead, Movember focuses on something we are not certain is effective.

Worse than that, it might even be doing harm. Detecting cancer in men for whom treatment will confer no benefit is very damaging. Even the diagnosis is damaging. Men are nearly ten times more likely to commit suicide after being told they have prostate cancer.

And the treatment is damaging too. Despite real advances in the definitive treatment (“radical prostatectomy” – for which there are several methods), the chances are that most men will be rendered impotent by the operation, their penises will sink back, and the majority will develop urinary incontinence (temporarily for many – lasting for two years – but for some lasting well after even that).

All this is so counter-intuitive that it’s hard to explain. Surely, if you’ve got cancer, then treating it earlier must be better? Not necessarily. Only if we know that treatment is better than no treatment. And we don’t know that about prostate cancer.

If Movemeber focused more on the things that we know are effective, and steered off controversial areas which divide doctors, men would actually be much better off.

Join the conversation

42 Comments sorted by

  1. Geoffrey Edwards

    logged in via email @gmail.com

    Quote: "If Movemeber focused more on the things that we know are effective, and steered off controversial areas which divide doctors, men would actually be much better off."

    I take it you don't read the text of there campaign posters?

    Here is a sample for you, Chris.

    Your diet and lifestyle choices can dramatically inf luence your health. Regardless of age, the most important thing you can do is stay healthy.

    Have an annual check-up:
    Find a doctor and make a yearly appointment each Movember…

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    1. Chris Booker

      Research scientist

      In reply to Geoffrey Edwards

      Yes but the problem is particularly with that paragraph referring to "have an annual check up". This is essentially advocating screening, the evidence for which isn't great (both in terms of prostate cancer screening, or even 'whether having an annual check up' actually improves mortality, quality of life, etc.)

      On the one hand, there's evidence that a lot of middle aged men don't see their GP or present with an illness, so I can see why they've put this in. But you see, that refers to men to…

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  2. Chris O'Neill

    Victim of Tony Abbotts Great Big New Tax

    "There are advocates for screening (often those doctors who treat prostate cancer) and those who discourage it (especially public health and primary-care doctors)."

    Faith in doctors is somewhat damaged by this. You can't trust them to do the right thing for you.

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  3. Laura Coulter

    Practitioner

    Oh dear Chris - I see from your photo you don't even have a moustache. What a party pooper.

    After all, don't you know that critique must never be allowed to get in the way of our cultural institutions - esp. those proporting to be for a "good cause", such as charity, aid and the likes with the public having very little information about (or, apparently, much interest in) what the money is used for. After all, Soup Strainers are such jolly good fun, we mustn't let all this other nonsence about research or facts get in the way.

    Though, perhaps you have a point. Maybe the organisers will take heed and next year, in the interests of transparency, offer our men-folk the option of just growing half-a-moustache to support the mental health bit, if they are not all that keen on the other?

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  4. Dianna Arthur
    Dianna Arthur is a Friend of The Conversation.

    Environmentalist

    I'm not sure if laws have changed; if a person dies suddenly and has not been to a GP or had other medical examinations in the preceding 12 months, then an autopsy is conducted even if death is quite obviously from natural causes.

    My father literally dropped dead on the kitchen floor due to a massive cerebral haemorrhage - we had to wait for the coroner's report before we could have a funeral.

    Had my father even bothered to go to a doctor, he would've been advised that his lifestyle of drinking was killing him.

    Thanks Dad.

    In conclusion; Movember, Tovember, Provember: whatever it takes to get men to take care of themselves instead of causing grief and misery for their families.

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  5. David Towl

    Health Promotion Practitioner

    Chris

    This seems like a pretty low and cheap shot at a charity which has done a great deal to raise the profile of mens' health in Australian and across the globe.

    Its rare to find male health promotion campaigns designed for and by men. While the whole movember beast isn't necessarily health promoting, it starts a conversation between men about their health - and that is something we know works to make populations healthier.

    Oh well....

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    1. Jason Bryce

      logged in via Twitter

      In reply to David Towl

      What?? Movember is a charity now? You have to be joking.

      Movember is part of the growing cult of 'raising awareness' campaigns that channel cash into the pockets of PR people and provide segments for breakfast TV shows.

      All that cash would be better spent on better food and better lifestyle options for people who struggle to afford good health - like more public pools and sporting facilities or discounts on sporting club memberships for health care card holders.

      Movember is one of those excuses for rich bored weirdos to drive their yacht around Australia (or whatever) for charity - "I'm doing this very expensive thing to raise awareness ..."

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    2. David Towl

      Health Promotion Practitioner

      In reply to David Towl

      Health Promotion Practitioners, are people involved in the practice of health promotion. Sometimes known as Health Promotion Officers or by a multitude of other terms, Health Promotion Practitioner is a collective term. See the Australian Health Promotion Association www.healthpromotion.org.au for more

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    3. Chris Richardson
      Chris Richardson is a Friend of The Conversation.

      Doctor

      In reply to David Towl

      Ok yep thanks David...I looked at that website. It all seems a bit like a re-badging of what we might have called Public Health back in the day. Do you think there's a bit of overkill now with all the para-health-type qualifications you can now get? Are we digging holes and filling them in again?

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  6. Peter Flinn

    logged in via Facebook

    There's an important aspect to the diagnosis which you implicitly refer to, but don't go on to elaborate. As someone who has had a radical prostatectomy, one of the many conversations I had with my urologist concerned my age and the possibiity that I might die of something else before the prostate cancer. In the end, I (we) decided I was too young NOT to have the procedure (59), and I was comfortable wiht that decision before the procedure.

    Diagnosis and subsequent treatment for older men does little to reduce the mortality rate for prostate cancer sufferers, which is why many studies show little benefit in treatment. By all means live a healthy lifestyle, but for those like me who are lucky enough to get treatment in time (so far, so good), I wouldn't want to put them off by leaving out this part of the discussion. I opted for a reasonable chance of a cure in the full knowledge of the consequences which I am still dealing with, but I'm glad I did it.

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  7. Michael Mcgregor

    Policy Analyst

    "All this means that one half of Movember, which aims to increase men’s awareness of prostate cancer and male mental health, is deeply flawed".

    Chris, as you would know, Aussie blokes are inherently bad at talking about what's going on inside their head. I would know, I’m a typical Aussie bloke.

    On a daily basis over the past 4 weeks I have had multiple conversations relating to the fur growing on my upper lip (or the lack thereof).

    It has generated conversation with my mates, family…

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  8. Alison Moore

    Senior Lecturer in Modern European History, University of Western Sydney

    Thanks for this Chris. We need party-poopers sometimes too. I think you put a reasonable case here for the general screening recommendation being a bit ill-conceived both because of its doubtful efficicacy and because of the potential negative effects of diagnosis in such a slow growing cancer.

    But the campaign seems to have been quite popular with young men, which is possibly its most powerful impact. Lifestyle dietary and other choices don't tend to produce drastic health problems overnight…

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  9. Anthony Nolan

    logged in via email @hotmail.com

    Facial hair is always a mistake.

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  10. Sue Ieraci

    Public hospital clinician

    It is interesting to juxtapose this article against the one a couple of weeks ago on the cultural significance of the colour pink for breast cancer campaigns.

    In that article, pink was discussed as a girly, under-the-patriarchal-radar colour - noticeabley not red. IN a similar way, facial hair is an exclusively male thing - a mark of hyper-masculinity, if you like.

    In both cases, the cultural campaigns and symbols have gone well beyond the original medical illnesses they targeted to become a rallying point for each gender.

    Men seem to be reporting a bigger-than-ever Movember this year, with a big participation and lots of conversation. If it helps men open up conversations about their health, that can't be a bad thing, I guess.

    What do the sociologists think of MOvember?

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  11. Richard Hockey

    logged in via Facebook

    No where does the movember campaign promote PSA testing. It may have in the past but this year they have been very careful to avoid this issue.
    R

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  12. Walter Adamson

    logged in via Twitter

    I understand your point about the false positives and the sometimes devastating consequences. What I don't understand is that a biopsy shows the real situation, as far best a sample can, and then the grades of the cancers whihc are found found speak for themselves don't they? (Plus considerations related to the patient and their age, ambitions etc).

    I'm about to have robot surgery to remove my prostate. The big decision was about which procedure, not IF.

    I get the PSA thing. I'm the opposite of a false diagnosis because my PSA is under 3. But surely prostate diagnosis by inspection and then biopsy is not misleading anyone? That's the bit I don't understand in your whole case.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Walter Adamson

      Walter - the logic of this discussion is similar to the dilemma of breast cancer screening:

      It's true that a positive result on a screening test leads to biopsy, which leads to a diagnosis of cancer. The problem at the moment is in predicting which cancers would have been fatal within a normal lifespan, and which would have been slow to develop.

      There are some aggressive forms that predict rapid deterioration, but this is not always the case. That leaves people like you with the dilemma - whether to go ahead with treatment, without the certainty that that particular cancer would be life-threatening. While there is no perfect pre-hoc predictive tool, most people would do what you have done, and opt for the surgery.

      We need to be very cautious about the concept of "unnecessary" procedures, judged post-hoc, when we have to act without the benefit of hindsight. It's the same argument as having a cesarean - if the baby came out perfectly well, it means you acted early enough.

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    2. Chris O'Neill

      Victim of Tony Abbotts Great Big New Tax

      In reply to Walter Adamson

      "But surely prostate diagnosis by inspection and then biopsy is not misleading anyone?"

      That's the whole point, it does, in fact it usually, misleads. At one time I believe, prostate cancer sufferers who had a Gleason score (the most important factor in diagnosis) of 6 were usually given highly invasive treatment like prostatectomy or radiation therapy without further diagnosis. However, opinion now is that more than the old criteria should be applied before invasive treatments are applied. This…

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    3. Walter Adamson

      logged in via Twitter

      In reply to Walter Adamson

      To Sue Leraci, for some reason your comment doesn't have a Reply button? Thanks for your answer and I now understand that the key is predicting which cancers would be fatal within the lifespan of the person in question.

      So the author is saying that given a biopsy and everything we know about a range of discovered cancers that the science of predicting what might kill an individual, all things considered, has serious unknowns?

      In the grading of cancers, and I only know the prostate case, you mean even the 8+ ones may be better left alone for many men who may in fact die of other causes in say 10 or 20 years - but it's a difficult call. Or is it the more marginal 6 and 7 that are at the heart of this problem of unnecessary procedures?

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    4. Chris O'Neill

      Victim of Tony Abbotts Great Big New Tax

      In reply to Walter Adamson

      "Or is it the more marginal 6 and 7 that are at the heart of this problem of unnecessary procedures?"

      If you've read what I said above then you'll probably guess that that is close to my view.

      Gleason 6: I don't think immediate action is usually justified
      Gleason 7: Borderline
      Gleason 8+: I'd say very few practitioners would say you have much choice other than invasive treatment.

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Walter Adamson

      Hi, Walter. The new commenting system here only allows replies to the head of each thread - so I'll reply to your second message here.

      Yes, the prediction models are much better than nothing, but imperfect.

      Here is a paper the describes one dilemma:
      Gleason Score and Lethal Prostate Cancer: Does 3 + 4 = 4 + 3?
      http://jco.ascopubs.org/content/27/21/3459.short

      And here is a general review:
      Prognostic Determinants in Prostate Cancer
      at http://journals.lww.com/journalppo/Abstract/2011/11000/Prognostic_Determinants_in_Prostate_Cancer.5.aspx
      (see if you can get hold of the paper - the abstract doesn't say much).

      Prognostication of outcome in prostate cancer is getting more sophisticated all the time, but, as I said, remains imperfect.

      The complex decision-making involves weighing up so many factors that I'm sure you already know about. If I were the age that you appear to be in your photo, I think I'd be making the same decision as you.

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    6. Walter Adamson

      logged in via Twitter

      In reply to Walter Adamson

      Hi Sue Lecari again (waving) my response to your 2nd response. Yes the surgeon who gave me a 2nd opinion was very much basing his advice on me specifically and my fitness, health, history etc. Whereas the first opinion, a man I also found excellent by the way, was more about overall statistics. Perhaps just a different way of working with patients.

      And then later in email correspondence the radiation oncologist said all things considered he thought that robotic surgery was my best option. (He…

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    7. Chris O'Neill

      Victim of Tony Abbotts Great Big New Tax

      In reply to Walter Adamson

      "Prognostication of outcome in prostate cancer is getting more sophisticated all the time, but, as I said, remains imperfect."

      To put it mildly.

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  13. Matthew Campbell

    Research coordinator

    Isn't the average age of death of a victim of prostate cancer actually older than the average age of death of a male generally? If this is the case then we do need to wonder why it gains so much attention. I hazard a guess that this is because of its male specificity-i.e. that prostate cancer is the male equivalent of breast cancer and therefore worthy of promotion as some kind of gender equality project.

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  14. Andrew Mccoy

    logged in via LinkedIn

    The credentials of the author seem pretty good to me. Clearly this is a man with a professional interest who keeps up to date with the research. Chris's call for the Movember movement to refine their message in line with best practice seems like a good idea to me, and I'm a 58 year old male.

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  15. Gerry Diamond

    retired

    I confess not to have formed an opinion on the merits or otherwise of the Movember compaign but my own very recent diagnosis with prostrate cancer has disturbed my comfortable complacency.

    From a position of near zero knowledge or interest I am suddenly propelled into this new world of medical dilemma, muddle and confusion where everybody else seems to have a view as to what I should do for the best apart from me.

    Mine is a Gleason 7 which seems to create the greatest uncertainty as to how to proceed. For example my GP says that at my age 68 and with my heart condition he thinks a watch and wait approach is appropriate whereas the urologist who produced my diagnosis following a biopsy recommends a radical prostatectomy. Others, inside and outside my family have suggested all other known treatments in between.

    Being risk adverse by nature I think I will go the full monty !

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  16. Mike Coleman

    Land Use Planner

    I watched my father die of prostate cancer in his fifties. Annual PSA screening, rising PSA, biopsy, brachiotherapy at 67 has NOT left me impotent, incontinent, or with a sunk back penis!
    I am disturbed that Prof Del Mar's article (without presenting any references or evidence) reads as if such outcomes are inevitable for the majority of men with prostate cancer. I'm not sure that was his intention, and it is certainly not my experience, nor my reading of a range of articles.
    Though the rash of Victorian-appearing rugby and cricket internationals is alarming!

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    1. Chris O'Neill

      Victim of Tony Abbotts Great Big New Tax

      In reply to Mike Coleman

      Mike Coleman: "I am disturbed that Prof Del Mar's article (without presenting any references or evidence) reads as if such outcomes are inevitable for the majority of men with prostate cancer. I'm not sure that was his intention, and it is certainly not my experience"

      Doesn't that mean that you're one of the lucky minority?

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  17. Pip Cornall

    logged in via email @gracegawler.com

    Thanks for having the courage to open this topic for discussion Chris.

    I’d like to talk about other diagnostic and treatment options for men with prostate cancer. As a director of a cancer charity in Qld, I run a program called prostate mates. In the course of this work many men have shared with me the debilitating impact of their prostate surgery – manual or robotic. My opinion, though anecdotal, is that a far higher percentage of men than commonly quoted in the medical statistics seem to suffer…

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  18. Peter Ormonde

    Farmer

    Personally I'd be far more impressed with a Beer Free November.

    I cannot agree with Tony Nolan that facial hair is always a mistake. Poirot proves the point albeit prissily. But it requires no particular talent or ability to grow a moustache of sorts. No great effort of the will or commitment. It does it all itself. All it requires is a level of self-interest or vanity.

    As to the more serious issue - the efficacy of screening - and perhaps more importantly, the scale and nature of the response…

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  19. Mark Goyne

    Lawyer

    Rather than all this puerile growing of mos, the men could pledge to do some hours of free labour for their chosen charities, for their pledges from their donors for money. That way charities get more benefits.

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  20. Tony P Grant

    Neo-Mort

    "Receptionists" and the privacy issue (or lack of it).
    I have worked for a "specialist" and witnessed the "eye-balling" of patients files by a number of receptionists over 30 years...gossip and most unprofessional behaviour, yes, they are not professionals...that is the point?

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    1. Reema Rattan

      Editor at The Conversation

      In reply to Tony P Grant

      Hi Tony,

      You're off topic (see our community standards) so I will remove your comment shortly unless you can tell me why I should not.

      Thanks,
      Reema

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  21. Matt Stevens

    Senior Research Fellow/Statistician/PhD

    While the merits of surgery verse thebwait and see are hard risks to judge, i still cannot for the life off me see the reasoning in bagging a huge fundraiser where the money goes directly to men's health. Clearly there needs to be significant dollars spent on prostrate cancer research so the appropriate treatment or not is provided. These debates probably happened decades ago with other cancers, but as usual men's health takes the backburner and men cop the blame for not attending health centres…

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  22. Chris Del Mar

    Professor of Public Health at Bond University

    Thanks everyone for commenting.
    There are a couple of things I would like to reply to.

    1. Talking about health is a Good Thing.
    This isn't self-evidence (however intuitive). A recent examination of all the trial evidence for health-checks that you can access (for free) in the Cochrane Library shows that they do not increase length of life. See http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009009.pub2/abstract
    However there are some things that worth checking: blood pressure; vaccine…

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  23. Paul Villanti

    Movember, Head of Programs

    As the Head of Programs at Movember, I thought it would be helpful if I clarified exactly what our position is on PSA testing and put right a couple of other inaccuracies that appear in some of the posts.

    As highlighted in the comment stream, there are many different views and advice on prostate cancer testing. As an organisation, Movember does not advocate a national prostate cancer screening program and is investing heavily in initiatives that address the key challenges that men face. As a…

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  24. Michael Bailes

    logged in via Facebook

    This, just published, article may be of interest
    though no where near a complete review
    Nutrition and benign prostatic hyperplasia
    Espinosa G.
    [In Process] Curr. Opin. Urol. 2013 23:1 (38-41)
    Embase

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