On Donahue, Mike Angelucci of the National Coalition of Free Men argued that “male judges and male politicians” discriminate against men. One of his supporting examples struck me, because I’ve heard this meme passed around anti-feminist discussions so often:
“That’s why our government spends four times more on breast cancer research than prostate cancer research, even though they kill the same number every year.”
It’s true that breast cancer research gets more government funding than prostate cancer research – although not “four times more.” Breast cancer research receives about twice as much funding – $900 million annually for breast cancer compared to $438 million annually for prostate cancer, according to the National Prostate Cancer Coalition.
The greater spending on breast cancer is at least partly due to decades of activism and pressure on Congress from women’s groups. Since men’s groups haven’t organized as well or as long, I don’t think “breast cancer vs. prostate cancer” is really a good way to measure government’s alleged preference for women (when the government does something only because of outside pressure, that’s hardly an example of government bias). But even ignoring that, breast cancer research should get more funding, not because of sex, but because of differences in the diseases.
Mr. Angelucci claims breast cancer and prostate cancer “kill the same number every year.” In fact, according to the American Cancer Society, 40,200 people die of breast cancer annually, compared to 28,900 people – a substantial difference. (Put another way, 130 people die of breast cancer for each 100 people who die of prostate cancer). It’s not the mortality rate alone that makes breast cancer scarier, however: it’s also that breast cancer typically strikes at much younger ages.
| age 39 and under |
age 40 to 59 |
age 60 to 79 |
|
| How many women develop breast cancer |
1 in 228 | 1 in 24 | 1 in 14 |
| How many men develop prostate cancer |
1 in 19,299 | 1 in 45 | 1 in 7 |
| Source: American Cancer Society | |||
We could argue back and forth about if it makes sense to spend more to reduce mortality among the young than among the elderly. On the one hand, one could argue that doing so implicitly suggests that elderly lives are worth less than younger lives, which (I assume) isn’t something anyone wants to claim; on the other hand, if the purpose of medical research is to extend life, then it’s utilitarian to put more resources into fighting diseases that strike younger ages (since we’ll get more additional years of life per dollar expended).
But no matter which side of that debate you come down on, it’s a debate about age, not sex. Given the real differences in mortality and age of onset, it’s a stretch to claim that the differences in federal funding for breast cancer and prostate cancer research is a sign of some government bias against men.
* * *
A postscriptal digression (but an important one): Something that breast and prostate cancer do have in common is that both of them kill disproportionate numbers of African-Americans compared to whites. From an ACS page on the subject:
About 132,700 new cancer cases and 63,100 deaths are expected among African Americans in 2003 according to the ACS guide, Cancer Facts & Figures 2003. Prostate cancer and breast cancer rates in black Americans provide the most dramatic evidence of the cancer gap.
- Black American men have the highest rate of prostate cancer and death in the world – more than twice the rates for white men in the US.
- African-American women are less likely than white women to develop breast cancer, but more likely to die from the disease.
- African Americans with cancer have shorter survival than white Americans at all stages of diagnosis.
From elsewhere on the same page:
Recently however, a landmark report called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care concluded that racial discrimination within health care settings contributes to poor medical care for many blacks and other minorities. Time pressures on medical professionals and low-end health insurance plans were also cited as reasons why minorities were more likely to get substandard medical care. The end result is that more African Americans and other minorities die from serious diseases today than white Americans, according to study authors.
Lower quality medical care was found even when minority patients’ income, age, medical condition, and insurance coverage were similar to that of white patients.
The page linked to, discussing solutions, notes that “more minority health care providers are needed, especially since they are more likely to serve in minority and medically underserved communities.” If this is right, then eliminating affirmative action in medical school will cause more minorities to die needlessly for lack of doctors working in their communities.
UPDATE: There’s a followup post to this post..
I question whether minority doctors are more likely to serve in minority and medically under served communities. It is my experience that the majority of doctors in free are not minorities but doctors who care about under served communities. Also the issue of minorities with the same health insurance getting lower quality coverage does not necessarily indicate discrimination. Consideration to the fact that many minorities who have health insurance from the places of employment go to the medical facilities in their communities. If the facilities in their communities are not up to standard then they will not get as good a quality of health care. Also the ability of the person following up on medical care has to be factored in to the mortality rate. This is not to defend the mortality rate among minorities. We need to do every thing possible to lower these rates. But citing medical discrimination alone as the cause of this does not address the whole problem.
Rusty Ford
u have a question and im doing a project about prostate and breast cancer and i need to find some similarties and differances and i have looked all over line and i cant find any possible ways they are different or the same i was hopung you can give me some ideas based the the information i have given you i will appeciate it i hope you are able to write back soon sincerely ashley v
Interesting discussion.
It’s good that you pointed out the difference in ages at which the two cancers tend to strike. This is the sort of important information which is lost when one looks only at broad statistics like “incidence per 100,000 people per year”.
As you say, we could argue about how we should value lives at different ages, but I think most people would prefer to cure diseases which strike down people in the prime of their lives, even at the expense of curing diseases that come towards the end of a full life. Clearly this would favor breast cancer research.
As for the 40,200 vs 28,900 deaths qualifying as a “substantial” difference–maybe. There are different kinds of substantial. Some diseases kill 40 people a year, some 400, some 4,000, and so on. In a broad sense, these two cancers are surprisingly comparable in (1) incidence and (2) social significance.
Maybe this is a little too actuarial (I spent a few years doing that kind of work), but arguably one should estimate how many *years of life* are lost to each cancer, rather than the *number of lives* lost to each cancer. If they had never gotten their fatal cancers, how much longer would our patients have expected to live? That would sensibly measure the greater impact of breast cancer.
Sorry, I have no statistics like that at my fingertips.
I looked up that National Prostate Cancer Coalition link in the Internet Archive, and the $900/$438 million figures are for estimated federal government spending. I doubt that state or other government spending changes the ratio much, so that email blurb about how the government spends “four times more on breast cancer research” is certainly wrong. Or more precisely, it is outdated, since some quick research suggests it would have been true as recently as the mid-’90’s. It would be interesting to compare the complete historical research efforts directed at the two cancers. If a disease that primarily affected women had been long underfunded, would we want to do a little catching up?
I suspect that private spending significantly favors breast cancer research (how many people show up to walk for a cure for prostate cancer?), but I haven’t found estimates of total private spending. It does seem like federal spending is by far the most significant source of research funding.
Because of the age differences you pointed out, naively comparing breast cancer to prostate cancer can be kind of an apples-to-oranges comparison. Would it be more comparable if we threw testicular cancer in there? Googling brought me to the Testicular Cancer Resource Center, where they say that about 7,600 men will get testicular cancer this year, of whom about 400 will die. Since testicular cancer strikes men most often between the ages of 15 and 35, the number of years of life lost to this cancer is going to be significantly greater than for 400 lives lost to breast cancer or prostate cancer.
Also, treatment for testicular cancer can kill you in a Darwinian sense by leaving you infertile at a young age. Does it matter? It matters a lot to some people. I don’t know how you could account for that. Ask people how many years of life they would give up if they could have their own children?
These three cancers are worth comparing because besides being possibly deadly, they have in common that they strike organs that are sexual or at least associated with sexual attractiveness. Their treatments often leave survivors either disfigured or disabled in ways that affect their view of themselves as whole sexual beings. Thus all three cancers can leave survivors feeling ashamed or embarrassed about their illness in similar ways. This embarrassment can keep someone from seeking medical help; it’s probably easier to ask about a lump you noticed in your neck than to ask about one in your testicle or breast. Or at least it used to be. Compared to their mothers, how many women today would ignore a lump in their breast out of embarrassment?
Research spending isn’t the only sensible way to spend money to save lives. All of these cancers are much less likely to kill you if they are caught early. We’ve raised awareness of the need for self-administered and professional exams for breast cancer quite a lot in, say, the last 20 years. Awareness of the need for prostate exams has also increased quite a bit. Maybe not quite as much, but I don’t think anyone has suggested that men need to be checking their own prostates once a month, so it’s not entirely comparable. You see attempts to raise awareness of testicular cancer, and the need for monthly self-examinations, but my sense is that a lot of work remains to be done. Hearing about the need for examinations isn’t enough–you have to pound it into people’s heads enough to motivate them to actually do the exams. It might make sense to spend even more money here for all three cancers.
I realize I’ve asked a bunch of questions without giving a lot of answers. Maybe I’ll try to crunch some numbers on a rainy afternoon. I think I could handle the math/actuarial part fine, but I don’t know if I could get the medical data in enough detail. Maybe some health statistician or economist will read this and write a paper. They can get funding for that sort of thing. Hey, that’s another aspect of this–how much more money is spent ferreting out the cultural inequalities that hurt women? Of course it should be roughly proportional to the inequalities out there…
In any case, these comparisons are not made in order to take funding from breast cancer or women and give it to prostate cancer or men. The feminist movement has done an admirable job of raising awareness about some issues of particular importance to women. Does awareness of some particularly male problems lag behind? Is there sometimes a cultural hostility to even asking if there are male issues that deserve attention? You don’t have to be an anti-feminist, or belong to some suspicious-sounding group of “Free Men”, to think so.
P.S. First, more money for colon cancer.
Interesting indeed! I don’t think the value of life for women over 45 vs men from 20 t0 35, would be quite so cavalier about the value of the golden years.
I have experienced the trauma of diseases on the friends and family of both types being discussed. I have had a former fiancee, aunt, sisters in law and several aquaintances who have been stricken with breast cancer. Most, as statistics show, in their twenties and thirties. Two, my aunt in particular, were over sixty. Now this begs the question, ‘Why waste treatment on the older women? After all, they don’t have much life left!’ All these women survived their
diagnoses for a minimum of 15 years, most of them, including one lady who is now nearing 80, are still living.
The men I have known, on the other hand, 8 in number over the past 30 years, died within two or three years after their cancer was found, and all from the disease itself, or from complications there-of.
So, the actual value of a human life seems to be not just age, but gender. It is not fashionable to support men’s issues, and hasn’t been since the sixties. Because political correctness swung from the other side to it’s current position this recently doesn’t make it right.
Gee, I don’t know. My mother is a very healthy 91 and my partners grandmother is a spry 96 and has just survived a melanoma, after fighting for treatment from a doctor who seemed to think she was too old to bother with. Weighing the value of a life, one against another, may be actuarially necessary, but it does not make for a very dignified discussion. A friend of mine recently died, with great charm, good humor, and dignity, of prostate cancer, and it has seemed to me that the survival rate of those thus afflicted is not very good — in part, it seems, because until recently the relatively ineffective digital rectal exam was all the screening available, and the PSA blood test is not all that reliable, although I have every year anyway. In short, most prostate cancers until very recently were not caught until symptoms sent someone to the doctor (as they did my friend mentioned above, who was at stage four by the time he was diagnosed), a point at which survival rates are pretty dismal.
We could align national priorities toward life and fund all this research sufficiently. Men need a new, reliable test for prostate cancer, which is treatable if detected early, although — yes — the treatment leaves some sexually compromised. These are emotional cancers — more than most — for both men and women; mutual support, not a war of the sexes is what is needed, along with more funding for research, a bit less Flash Gordon military hardware. How about prostate cancer and breast cancer vs. obscene military expenditures and a broken health care system. And yes, more for colon cancer, a bigger killer than any of them. I confess that as a man whose maternal relatives have been ravaged by that disease, I’m not a little concerned by that.
Well, there has been a long term differential in spending (prostate cancer research funds are catching up), but that means cumulatively, breast cancer has had much more support. And it shows. The treatments for breast cancer are far more sophisticated (SERMs exist, many of them, but no SARMs – selective androgen receptor modulators – and men suffer from androgen deprivation therapy, a demasculinization, in addition to major internal surgery, incontinence, and sexual problems).
Some of the problem is a function of how Congress works — rather than representing “We The People” it represents “Voters Who Complain, Promise Money Or Vote.”. Some of the problem is how the sexes work — women are more willing to seek medical care than men.
Congress doesn’t need to provide research dollars for why men don’t seek medical care — most of Congress is men, and men seem to have a pretty good grasp on why they don’t seek medical care. It’s not macho to have annual prostate exams, or any other health exams. I’ve not known men to sit around and discuss health issues, and no other issue is more taboo than the prostate exam — it’s a subject of joking and derision and no small amount of homophobia.
Male attitudes about masculinity and health care are far behind those of women — women’s groups are working to empower women who’ve experienced radical mastectomy to remove the shame of losing a breast. For androgen-specific cancers, unfortunately the treatment is going to involve demasculinization — the cancer is fueled by testosterone and reducing testosterone levels has a way of doing that. The corresponding behavior, men empowering men who’ve experienced whatever demasculinization is associated with treating those diseases, needs to happen as well. Congress can play a role in that — it can authorize education campaigns — but men need to be involved as well.