One of the precursors of getting older is that you start be more concerned about your mortality, particularly if you start hearing of family members, friends’ parents / siblings / partners getting ill and surviving; or succumbing.

And there aren’t many diseases which can strike fear like cancer can. Why? Because it can affect you regardless of sex, age, lifestyle and race; and the number of people who are suffering globally is staggering.

To put it into perspective, the WHO (World Health Organisation) has stated that cancer is a leading cause of death worldwide with an estimated 7.6 million people dying from it in 2005 alone. To make it just that little bit more menacing, they estimate that in the decade from 2005, 84 million will die from cancer. Unfortunately, many of these deaths originate in low and middle-income countries where sufficient resources are unavailable and education is limited.

How many times have we heard “my dad has colon cancer” or “my friend’s wife died of lung cancer and she didn’t even smoke!”? We can trot through life in a haze of ignorance thinking it will never happen to us as long as we eat moderately well and lead relatively healthy lives. But reality is never disease free and cancer is something that everyone needs to have basic information about so that if we even suspect something’s not right, we deal with it.

Cancer affects anyone across the board but there are certain types which are affects one gender more than the other. There is also the hereditary issue to take into question, race, geography and what type of lifestyle (diet, alcohol/tobacco intake, fitness and stress levels) one leads.

The WHO (World Health Organisation) states that the main types of cancer in general are: lung, stomach, liver, colorectal, breast and cervical.

Cancer and men

But, let’s veer away from the big picture and focus on men. As previously mentioned there are certain cancers which only affect men—prostate, testicular and more rarely breast and penile. Within these cancers, race and lifestyle definitely affect which are more common where. In-depth studies have been conducted and it is interesting to note that the most common male cancer in Japan is not the same in the UK, France, India or Malaysia.

For example, according to the CDC (Centres for Disease Control and Prevention), the following are the top five cancers affecting men in the USA: prostate, lung, colorectal (colon and rectum), bladder, melanomas of the skin. It must be noted that there is a clear definition between common cancers among men and those that are leading causes of death. The CDC states that approximately 300,000 men die per year due to some form of cancer in the USA, with lung cancer having the highest mortality rate.

As a matter of comparison, the most common cancer affecting men in the UK according to the NHS is prostate like their American counterparts; while stomach cancer affects the most males in China, liver cancer in Thailand, and lung cancer is the most common or second most common in countries like Indonesia and Laos.

Odd one out

Testicular cancer is actually one of the less common cancers but what it lacks in quantity, it more than makes up for in unfairness as it seems to only affect younger men between the ages of 15 and 40. On the bright side, it is highly treatable even when it has spread beyond the testicle. This is also one of the few cancers which can be caught early through self-examination, early detection and treatment.

Risk factors

A risk factor is basically anything that can affect your propensity and risk for getting an illness. Listed below are the risk factors associated with the common male cancers.

● Prostate
Age, family history, ethnicity, diet, smoking, alcohol consumption, weight and fitness levels

● Lung
Smoking, exposure to second hand smoke, family history, exposure to asbestos or other cancercausing substances, alcohol consumption, smoking related diseases like emphysema

● Colorectal
Advancing age (mostly affects people aged 50 or older), family history, low fitness levels, obesity, inflammatory bowel disease, lack of fruit, vegetable and fibre in diet, smoking, alcohol consumption

● Stomach
Unbalanced diet (high in salt, low in fruit and vegetables), smoking, family history, stomach inflammation, polyps, Helicobacter pylori infection (causes digestive illnesses like gastritis, ulcers)

● Bladder
Increasing age (40 and above), family history, smoking, previous cancer treatment, bladder inflammation, exposure to certain chemicals which are used in the paint/textiles/dye industries

● Testicular
An undescended testicle, family history, age, abnormal development of testicle, race.

On the local front

To get further professional insight, EL posed a few questions to Dr. Saunthari Somasundaram, the medical director of the National Cancer Society of Malaysia.

Her formidable role encompasses direction of operations, clinical and educational services, and counseling people with cancer and their caregivers.

Do the most common male cancers in Malaysia follow the global trend?

The main cancer, i.e. lung is fairly similar in most countries as they all have a common risk factor—tobacco. The differences between the other others are due to local demographics, e.g. ethnicity, diet, culture, environment. Also health policies that pick up certain cancers more accurately will affect the numbers.

Nasopharyngeal (nose) cancer is higher in Malaysia because southern Chinese are genetically more predisposed to this type of cancer. Prostate cancer is documented as being higher in countries which have national level screening programs which test men regularly.

Prostate cancer is an indolent cancer meaning many sufferers do not realise they have it and will die of other health issues; and in these circumstances there will be no documentation of the cancer. Stomach cancer is higher in countries which do not have widespread refrigeration, where food is salted for preservation.

How does a typical—aged 25–30, normal diet, average stress levels—modern male’s lifestyle contribute to cancer developing?

The majority of cancers are nearly exclusively linked to lifestyle choices. Lung cancer is nearly exclusively linked to tobacco usage in any form as is a multitude of other cancers: pharynx, larynx, mouth, kidney, bladder, pancreatic

Has medical care improved in Malaysia recently?

Yes, definitely. There are more facilities and treatment options available. There is no universal care which means that there is a disparity in services in locality and affordability.

The other issue is that individuals are not coming forward for treatment early enough in the disease stage to have successful treatment. Many wait until the disease is advanced or seek traditional /alternative therapies before reverting to conventional treatment which may be too late.

Which type of male cancer has the most success ful cure rate? And can you even say ‘cure’ with cancer?

All cancers have a chance of successful treatment depending on the stage in which they are diagnosed and treatment is initiated. ‘Cure’ is a term used to signify five year survival. If a person is cancer-free for five years post-treatment, this is termed as cured as the chances of the cancer returning are small.

However, this term isn’t used as much as before. As treatments advance, more people live longer with cancer despite not achieving a state of being ‘cancer free’. Cancers which are slow growing, e.g. prostate, or those that respond well to therapies, e.g. colorectal, testicular; are deemed the more successful rate of getting better.

How do men deal with the situation when they are diagnosed?

Men generally do not express their emotions as visibly as women so it is difficult to ascertain. In Malaysia society is still very paternalistic. The male role is that of the provider and main decision maker. When a man gets cancer, his role is under threat. A man doesn’t have as many avenues to share and express their fears or emotions.

Is it true that breast cancer in men is on the rise but men are bashful about discussing it?

Male breast cancer has the same risk factors as women. With the rise of female breast cancer, you will see a rise in male too though in much smaller numbers.

Of course men are still bashful about breast cancer. Cancer in any form holds a stigma in Malaysia. One which is unusual and primarily related to women will therefore be open to greater stigma and ridicule.

How aware is the modern man of the different types of male-dominated cancers?

There is greater awareness due to international programmes and awareness drives, especially for prostate cancer.

There is more awareness in countries which have adopted national level population based screening programs.

However in Malaysia, awareness for colorectal (bowel), stomach and testicular cancer is still low. The fight is continuous and has to be sustained until cancer is prevented or cured.