Cancer - there's a time and a place for the stiff upper lip

Like London buses, you wait a while and then they come along together. Today we've had not one but two stories about cancer death rates in the UK - one from an international perspective and one comparing men and women.

In a study of nearly 20,000 people from six high-income countries, Britain stood out as having lower cancer survival rates (ref 1). Importantly, the people surveyed in Britain knew just as much as those in Australia, Canada, Denmark, Norway and Sweden about the early signs of cancer, but were more reluctant to get them checked out by a doctor. Speculation in the media about why this is the case has been rife - is it the 'wartime mentality' of stiff upper lip? Is it concern about wasting the GP's time? Surely that should be for the GP to decide.

When British men are compared there may be similar factors at play. A report by Cancer Research UK, the Men's Health Forum and the National Cancer Intelligence Network shows that British men are more likely to be diagnosed with cancer and more likely to die from it than their female counterparts (ref 2). Once sex-specific cancers like breast cancer, cervical cancer and prostate cancer are taken out of the equation, the differences between the sexes are even bigger.

What factors are at play in this deadly game? We can't do much about fundamental biological differences between men and women. But we can all buck any trend that might be related to lifestyle factors like smoking, diet and physical exercise. If you're reading this blog, you clearly have a vested interest - so take the next step and leap to myhealth where you can get a personalised idea of your 'place in the queue' in terms of heart disease. It's relevant to cancer, too, because many cancers are linked not only to smoking and excess alcohol (statement of the obvious, I know!) but also to weight, diet and lifestyle.

It may also be down, at least in part, to embarrassment. Men don't attend the GP as often as women do - they don't need contraception or antenatal checks and don't get invited for smears, for a start - so they may not feel as comfortable in the GP's surgery. If they get early symptoms of bowel cancer like bleeding from the bottom, maybe they're more likely to bury their heads in the sand and hope it will go away.Of course, where cancer is concerned, 'going away' is not going to happen. More importantly, the earlier you're diagnosed and treated, the less extreme your treatment is likely to be and the better your chances of long-term survival.

It's important to remember that if your GP decided you don't need investigating, it will usually be for very good reasons, and they should be happy to explain them to you. If I referred every patient who ever came to see me worried about cancer, I would probably swamp my hospital's entire cancer services single-handedly. I'm often able to reassure patients that their symptoms are due to a minor cause, but that's not always the case. And if I don't hear about your symptoms, that's a conversation we can't have.


1) Forbes, L. et al. 'Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?' British Journal of Cancer, 2013.


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