At a pub in one of the rougher areas of Walsall, a nurse in uniform chats to two men as they lean at the bar, pint in one hand, cigarette in the other. The topic of conversation is testicles: specifically, whether the men check them for potentially cancerous lumps when they're in the shower or bath. Public health nurse Jane DeVille-Almond admits it can feel uncomfortable talking about intimate health matters in a smoky public bar. But if she didn't go out and meet the men on their own territory, she knows from past experience she wouldn't get to speak to them at all.
"I also work part time for a GP practice," she says. "And I once spent a year writing to male patients trying to get them to come in for a health check." Her efforts drew a grand total of nine men to the surgery. At a pub, where she invites patrons to a screened-off area for an informal health consultation and some basic tests, she can net as many as 60 takers during a three-day stint.
"I did feel a bit apprehensive at first approaching these burly, tattooed blokes and asking them personal questions," says DeVille- Almond. "Most of them would have to be on their last legs before they'd go to a GP. But when I take them to one side for an individual consultation, they seem to really welcome the chance to talk. They'll tell me about health problems that have been niggling them for months, and we can get them checked out."
Although women have become much more health conscious in recent years, the government is concerned that too many men seem to fall through the net when it comes to health promotion and picking up on early symptoms.
Yesterday, public health minister Tessa Jowell launched a new report on men's health and promised to redouble efforts to raise men's health awareness and persuade them to seek treatment for worrying symptoms as soon as they spot them.
The report, Men's Health - A Public Health Review, calls for a national strategy targeting men's health. It has been compiled by the Men's Health Forum, a lobby group whose members include the British Medical Association and the Royal College of Nursing. Northern Ireland GP Ian Banks, who co-presented television's The Good Sex Guide with Toyah Wilcox, chairs the forum. He believes men are conditioned from school age to believe that only women worry about their health.
"You're dealing with a mentality that says men just don't talk about these things. There's a huge lack of awareness and men seem quite happy to neglect themselves. And as for getting symptoms checked out, most of my male patients hit the ground running as soon as they hear the sound of a pair of rubber gloves going on. For every pound spent by the government on men's health, £8 is spent on women's health. When you point this out, some people label you anti-woman, but I'm just highlighting an anomaly."
Certainly, the scale of male ignorance on health matters is alarming. More than a third of men in the UK say they know nothing at all about prostate or testicular cancer, according to a MORI opinion poll due to be published next month. Four out of five did not know there was a simple blood test for prostate cancer and only one-third said they would have such a test if they knew they had prostate problems.
Yet prostate cancer kills 11,000 men every year in the UK. Within 20 years it is set to overtake lung and breast cancer as the most common form of the disease, according to Macmillan Cancer Relief. Less than £1m is spent annually on research into prostate cancer, compared with the £16m spent on breast cancer research. Testicular cancer is the most common cancer among men between 20 and 35. Cases have doubled over the past two decades, although 96 per cent of men with testicular cancer will make a complete recovery if it is detected early enough.
Peter McDevitt, a Northern Ireland district nurse, was diagnosed with testicular cancer eight years ago at the age of 28.
"I noticed a pea-sized lump in my testicle. It was like a little cyst and I really didn't think it was anything to worry about. But I thought I'd better get it checked so I made an appointment to see the doctor the following week. My wife wasn't happy about that and she made me go and see the doctor straight away."
The GP sent Peter for an ultrasound scan the following day. It showed he had a tumour: "I had surgery to remove it two days later, and after three weeks' recuperation they started me on a course of chemotherapy, just in case the cancer had spread."
His first child was born on the last day of his chemotherapy. Since then he has gone on to have two more children: "Fortunately it seems they caught it in time and I'm fine now. What with the chemo and the surgery I was told I had a 50-50 chance of becoming sterile so I was delighted when my daughter came along and then another son. I use my own experience as a door opener with my male patients when I try to get through to them about issues such as self-examination. There's this attitude among men that when you have a health problem, if you ignore it, then it'll go away. But the chances are it won't. And just look what I would have missed out on if I hadn't dropped by at my GP's surgery."
Ken Richards, 51, a coroner's officer in Southampton, might have avoided radical surgery if he had gone to the doctor sooner. "I'd come across prostate cancer through my work but I'd always thought of it as an old man's disease, until I got it at the age of 48. I was having a few problems with getting up in the night to go to the toilet. Sometimes I'd be bursting but when I got to the bathroom I just couldn't go. I was also going to the toilet a lot at work, and then I read this was one of the classic symptoms of prostate cancer.
"Even then I left it for six or seven weeks before going to the doctor. I was quite busy and to be honest I just didn't want to find out I had something serious. The doctor sent me for a blood test and they told me it was cancer. Because it was quite advanced, the only option was surgery to remove the prostate gland. It hit me particularly hard as I'd already lost my wife to breast cancer when she was 35. Because of my diagnosis, my five brothers have all been checked out and given the all clear. You do sometimes wonder 'Why me?' But then you realise: 'Well, why not me?'."
Seek medical advice if you have any of these signs and symptoms:
Frequent passing of urine, especially at night
Poor urine stream; straining or urgency
Sudden inability to pass urine
Blood in the urine or semen
Lumps on one or other testicle; check each month.
The campaigning group Men's Health Matters provides a nurse-led advice helpline, open every weekday evening on 0181-995 4448.