Every year in October, we mobilize against breast cancer with Pink October. And we continue in November, this time against prostate cancer, with Movember. A month to talk about women's illnesses and then a month to talk about men's illnesses. What is the point of " gendering" the mobilization ? We talk about it!
Who is concerned ?
Breast cancer affects 58,500 people in France each year (2.2 million worldwide) and causes 12,000 deaths (685,000 worldwide) per year. It is the deadliest cancer in women. It occurs in 80% of cases after the age of 50. It also affects men, who represent 0.5% of those affected.
Prostate cancer is exclusively male. There are 50,500 new cases per year in France (1.3 million worldwide) and 8200 deaths (400,000 worldwide). 95% of cases occur after the age of 55.
What do breast cancer and prostate cancer have in common?
These two types of cancer have a lot in common. First, while they mainly affect the " senior " population, they do not spare the youngest and are particularly aggressive in subjects under 50 years of age.
At the same time, these are cancers that, when caught early, show good prognosis for the success of treatments. Mortality from these cancers could be greatly reduced by detecting them earlier.
The crucial importance of screening. However, only 52% of women and 42% of men of screening age do the tests.
Are there the same obstacles to screening for women and men ?
While these two cancers have in common that they affect intimacy and sexual health, which in itself can be a reason for apprehension for any individual, other causes are put forward to explain the insufficient level of screening. These causes are not the same in women and men.
Demographer Isabelle Teychené classifies women's obstacles to breast cancer screening into 3 categories :
Socio-demographic factors
Generational aspects (whether or not they have been made aware, at different ages of life, of health prevention campaigns, whether for breast cancer or other diseases), issues of access to health (medical desertification has significant effects on the female population in rural areas), the marital situation (women in couples are screened more often than widows, etc.) divorced and single), the level of qualifications (it is among the most highly educated women and those who do not have qualifications that screening lags the most), the number of children (the more it increases, the less up-to-date women are with their mammograms)...
Here, we obviously think first of the fact of having women in one's family who have been affected by breast cancer, but the demographer also focuses on the overall health trajectory over several generations, showing a stronger propensity for screening among women who come from families where health is important and where there is a reflex to consult professionals regularly for the purpose of care as well as prevention.
Women's perception of women's health care
This is where the obstacles linked to a bad experience of gynaecological examinations come into play. Between gestures perceived as intrusive or even brutal, the feeling of being treated with condescension or even of being infantilized, guilt-inducing or even humiliating remarks, many women show a certain mistrust of women's health actors.
The obstacles to screening for male cancers are first and foremost to be found in a lack of information, according to a recent report by university hospital teacher-researchers. Lack of information about the risks, lack of information about the tests needed for screening, and even a lack of knowledge of anatomy (many people don't know exactly where their prostate is located).
In addition, there is a series of contradictory study results on the benefit/risk ratio of prostate cancer screening: some studies establish an overdiagnosis of prostate cancer, leading to surgery and/or treatment, whereas a majority of these cancers are said to be " latent", i.e. with a slow and non-aggressive progression. However, it is not yet possible to distinguish aggressive prostate cancer from " latent " cancer through screening actions.
In the meantime, the promoters of the Movember event argue the usefulness of a time dedicated to men's diseases in the calendar of citizen attention because of the less attention paid by men to their health and the excess male morbidity and mortality that this induces. It may be that the situation has changed with Covid-19 , which will have made us all more aware of the importance of taking care of our health.
To be continued, over the long term...
The terms of the debate on gendered medicine
The subjects of men's health/women's health necessarily lead to the question of gendered medicine. This question is most often addressed from the perspective of the biases of medical research and the pharmaceutical industry.
A large body of literature has highlighted the impacts of these biases on diagnostic protocols (e.g. under-diagnosis of the risks of osteoporosis in men and cardiovascular disease in women), the side effects of treatments (when drug tests are carried out on a predominantly male population) and the interactions between caregivers and patients (when pain is not considered with the same attention depending on the gender of the sufferer).
This gendered approach to health issues must be complemented by the psychosocial dimension and the weight of gender stereotypes must be integrated into the relationship that individuals have with their bodies, their psyche, illness, prevention, care, fear of death, etc. These deeply intimate questions are obviously crossed by the influxes of collective mentalities. They collide with our conscious and unconscious perceptions of strength and fragility, performance, emotions...
Therefore, if we want to better protect everyone from the risks of disease that can be avoided or better treated if we are treated early, we must certainly work to ensure that the voices of women and men can be expressed more freely and that they are heard on what hinders and levers prevention.
