Prostate vs. breast cancer
Prostate cancer and breast cancer have a lot in common, although they’re very different as well. The first affects men only, and the second almost entirely women (although about one in a hundred breast cancer patients are men, a fact which should be much more widely publicized, IMHO). They are both influenced by hormones. And they both, in an odd sort of symmetry, cause about the same number of deaths per 100,000 per year.
But, as Leslie Eastman at Legal Insurrection and many others have pointed out, the amount spent on the diseases differ:
Dan Zenka, the Prostate Cancer Foundation’s vice president of communications, says the similarity in numbers is hard to ignore. “Prostate cancer is to men what breast cancer is to women,” he told The Daily Caller.
Breast cancer awareness advocates have done an inspired job getting out word and excitement for their cause. Despite their success, prostate cancer has been left in the dust ”” both in terms of awareness and federal funding. Case in point, prostate cancer research receives less than half of the funding breast cancer does.
In fiscal year 2009, breast cancer research received $872 million worth of federal funding, while prostate cancer received $390 million. It is estimated that fiscal year 2010 will end similarly, with breast cancer research getting $891 million and prostate cancer research receiving $399 million.
Even when it comes to private foundations, the picture is the same. For example, at the American Cancer Society, breast cancer receives about twice the number of grants as prostate cancer.
Kevin Johnson, the senior vice president of public policy for ZERO-The Project to End Prostate Cancer, chalks much of the disparity up to the differences between men and women, specifically the way each deals with their health concerns. Women, Johnson says, tend to be acutely aware and outspoken about their health concerns, while men shy away from such discussions.
Interesting points, and I have little doubt that the last paragraph expresses some sort of truth about the differing attitudes of the sexes when it comes to disease.
However—and it’s a big however—I’ve noticed a glaring omission even in rather lengthy articles such as the one quoted above, which appeared in The Daily Caller. There is actually an enormous difference in the statistics between the two diseases—one that often goes unmentioned, and which I believe has some significance in terms of how much publicity each disease gains. That difference lies in the fact that, although the numbers of deaths for each disease are very similar, the ages of the victims at death are very different indeed.
Simply put, breast cancer is a disease that is much more likely to kill people in the prime of life, whereas prostate cancer tends to strike much later. This is not to say that old people of either sex shouldn’t be treated and cured, or that their diseases are unimportant. They should be treated, and they are important. But it is natural to focus more attention on a disease that kills a greater proportion of younger people.
Take a look at the statistics and you’ll see the magnitude of the differences I’m talking about. Here are the figures for prostate cancer:
From 2006-2010, the median age at death for cancer of the prostate was 80 years of age. Approximately 0.0% died under age 20; 0.0% between 20 and 34; 0.1% between 35 and 44; 1.6% between 45 and 54; 8.3% between 55 and 64; 20.0% between 65 and 74; 37.6% between 75 and 84; and 32.5% 85+ years of age.
The age-adjusted death rate was 23.0 per 100,000 men per year.
And here are the figures for breast cancer:
From 2006-2010, the median age at death for cancer of the breast was 68 years of age. Approximately 0.0% died under age 20; 0.9% between 20 and 34; 5.3% between 35 and 44; 14.6% between 45 and 54; 21.6% between 55 and 64; 20.2% between 65 and 74; 21.5% between 75 and 84; and 15.9% 85+ years of age.
The age-adjusted death rate was 22.6 per 100,000 women per year.
Note the curious symmetry of the death rate, which is almost identical for the two diseases. But that’s where the statistical symmetry ends; breast cancer operates as a very very different disease in terms of age. Although about 1.7% of prostate cancer death occur in people under 55, a whopping 21% of breast cancer deaths occur under that age. By age 64 the death percentage totals have become 10% for prostate and about 42% for breast. By age 74 it’s 30% for prostate and about 63% for breast. By age 84 it’s 68% for prostate and 84% for breast. The remainders of the deaths occur after the age of 85: 32% for prostate and 16% for breast.
Each disease can have particularly horrific aspects in terms of sexuality and sexual functioning, and it’s really not a competition to see which is worse. They’re both plenty bad enough, although fortunately there are a lot of long-term survivors also. And they both need more research in order to make even more progress against these common killers. But it’s no real mystery as to why the loss of a relatively young person would tend to get more attention than the loss of someone closer to the natural end of life, is it?
This may not be the only difference that leads to the funding and research differential, of course. I would imagine there are others, and some may be gender-related. But I haven’t noticed that other diseases that affect men in particular have been stinted as opposed to women’s diseases. For example, heart disease, which tends to affect men at younger ages than it affects women, has certainly been no orphan when it comes to research and funding.
Don’t know. Do you think it would get near the publicity and dollars if these young women were dying of arm cancer? Don’t think so.
And as for the research money, I believe breast cancer as well as AIDS, get proportionally much more money than other diseases that kill more people.
KLSmith: actually, I think it would, although of course cancers that affect sexual parts (such as both breast AND prostate) do get a special amount of attention. But I think if arm cancer was killing at the rates that breast cancer is, and especially if it were killing comparable numbers of younger women, it most definitely would get a ton of attention.
Look at the statistics for breast cancer rates (and breast cancer death rates) among women and you’ll see why it gets so much attention. And that page doesn’t even show the age differentials that I’ve mentioned in this post, which make breast cancer have such a huge impact.
Note, by the way, the symmetry of the incidence of prostate cancer in men. Again, the chart doesn’t show the big difference, which involves age.
Another fact:
There is no question, though, that diseases sometimes get attention that’s disproportionate to their impact on the population in terms of number. Breast cancer, however, has got the numbers.
IT is helpful to read this classic article on the subject in order to have a more informed basis for discussion.
http://www.theatlantic.com/past/docs/issues/96jun/cancer/kadar.htm
My younger brother, approaching retirement, has been diagnosed with prostate cancer.
The pull quote from his discussion with his doctor was, “Lots of men die with prostate cancer; not so many die of prostate cancer.”
He has elected not to treat it surgically. (Radiation only, I think.)
GLEN: actually, I’m fairly unimpressed by that Atlantic article.
I agree with it that many of the seeming sex-related differences in medical funding and research are not as sex-related as they seem (in fact, that’s the point of my post).
But on the specific topic of breast vs. prostate cancer, that rather long Atlantic article goes on and on and on about the funding differences between breast and prostate cancer and only devotes one brief and very general sentence to the all-important age differences:
Not only that, breast cancer does NOT attack a larger number of patients, as you can see from the data I presented in my previous comment, from the CDC. The relevant figures are that prostate cancer attacks men at a rate of 137.7 per 100,000, whereas breast cancer has an incidence of 123.1 per 100,000. And, as we’ve seen, the death rates for the two diseases are very similar to each other, as well. There are only slightly more women than men in the US, so these incidences should not translate to significantly more breast cancer patients compared to prostate cancer.
DJMoore: that’s a good point. I wonder whether the death statistics on prostate cancer are for men who have it and yet die of other causes, or whether the death statistics are limited to those deaths that are from the cancer. I would assume the latter, but I don’t know whether that’s correct.
I’m always a bit skeptical whenever statistics appear to support some aspect of apparent societal discrimination. I’ve yet to find a situation where natural circumstance wasn’t a strong contributing factor. I find that generally things are the way they are for reasons impossible to dismiss as simply societal capriciousness.
In this case, I think it probable that the public’s perception as to the age difference is significant. But the statistics reveal an interesting and natural correlation in those age differences.
In women:
From 2006-2010 the median age at death for cancer of the breast was 68 years of age. The rate of breast cancer nearly triples from 5.3% to 14.6% after the age in women of 45. Statistically, that is the early onset of menopause in that women over 45 have less than a 1% chance of getting pregnant using their own eggs.
In men:
From 2006-2010, the median age at death for cancer of the prostate was 80 years of age. The prostate cancer rate takes a similar jump from 8.3% to 20.0% after 65. The official retirement age for wage earners, historically men. It’s when we become eligible for Medicare and arguably the onset of old age.
Like it or not and, not that other factors aren’t of value but at the most basic level men value women for their sexual attractiveness and child bearing ability. Those physical qualities start to be lost and decline at the onset of menopause. By age 68, a woman is entering ‘the crone’ phase and unfortunately our society doesn’t express much appreciation for the wisdom of its elders, male or female.
Similarly and, not that other factors aren’t valued but at the most basic level, a primary consideration when women evaluate men is their ability to provide resources for child raising, whether ‘the nest’ ever has children or not. The cliche of the highly eligible bachelor is apropos, especially the more desirable the woman.
But at retirement age and in general, a man’s ability at 65 to provide resources is pretty much set to whatever he’s been able to acquire. At 80, he’s reached his old age and any further use of his stored resources represents a decline in inheritance for his heirs.
All of this is perhaps not definitive but IMO certainly relevant when considering the discrepancy between prostrate and breast cancer research funding.
It’s true that prostate cancer is a disease for older men. It’s also eminently treatable. Though breast cancer is as well before it metastasizes, but there are obvious self-image issues there. With genetic screening we’ll see more taking Angelina Jolie’s tact. If that is available to more people, query whether it will make sense to continue to pour that much money into research for it. Perhaps it will. Perhaps there are crossover findings that aid with all types of cancers. I dunno.
holmes:
Angelina Jolie had a gene that predisposed her to breast cancer. Screening could only uncover the small percentage of breast cancer victims who have that gene. It is estimated that about 5% of breast cancer victims have the BRACA gene. So it really doesn’t affect most of the sufferers from breast cancer.
By the way, for what it’s worth, the BRACA gene is actually quite important in terms of male breast cancer. As I wrote in the post, one out of a hundred breast cancer cases are in men, which of course is a great deal fewer than in women. But it turns out that about 50% of those male breast cancer cases have the BRACA gene.
Plus, the BRACA gene has an influence on prostate cancer as well:
A slight tangent:
Vitamin D Prevents Cancer: Is It True?
See page 4 of this pdf for cancer incidence vs. Vitamin D levels. It is projected that a “Serum 25(OH)D” level greater than 50 results in an 83% reduction in rate of breast cancer incidence.
Observation of a nurse that was treating my sister: *all* of the breast cancer patients we see are vitamin D deficient ( < 30 Serum 25(OH)D level).
The *only* way to know what *your* vitamin D level is is with a blood test. This can be done via mail and cost about $65 (single; $220 for 4). Available at ZRT Lab. If you live in the northern part of the U.S. or in Canada, or avoid the sun, it is *quite* likely your levels are lower than desirable.
DJMoore,
One of my grandfathers was diagnosed with prostate cancer around the age of 80. His doctor’s recommendation was no treatment because most prostate cancers are slow growing and my grandfather was likely to die of something else before the cancer became a problem. At the time, treatment would probably have been more of a problem than the cancer itself. Grandad died several years later, but I am glad he didn’t have to undergo surgery or any kind of chemotherapy.
This is a link to a website with data and graphs about years of potential life lost to various kinds of cancer. Years of potential life lost depends not only on the frequency of the disease but also on how early in life death occurs. In the instance of breast vs prostate cancers, the potential years of life lost is 3 times as great for breast as for prostate.
http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=96&coid=930
Another significant issue–not dealt with in the above link–is the quality of life between first symptoms, diagnosis, and death.
age is the all-important difference
I see some reaching going on. Tell the age thing to Frank Zappa or Dan Fogelberg to name but two. My best friend is dying from it now at age 65. Or is 65 too old to care about too?
Better answer: women were already organized by virtue of the women’s movement and a slight little pivot was all it took for the movement to embrace breast cancer as a feminist cause. Men meanwhile were situated quite the opposite. Go read Eastman’s post again.
My father and two of his brothers all had prostate cancer when they died. None died from it. It is very common for men with prostate cancer to die from something else before the prostate cancer can kill them.
A horrible post manifesting a horrible attitude. Maybe it gives us a little window into how it got this way. We don’t need to diminish one to embellish the other. People are people.
G Jourbet:
You are the one who should go read my post again, and please read it more carefully. You have completely mischaracterized it. I have made several statements about how important I think research for both diseases is, and also that age should be no deterrent to such research and treatment.
There is no “reaching” here. I am attempting to explain the disparity that exists in research efforts and funding between the two diseases, and pointing out an age difference that is both large and real, a difference that is often ignored in presenting statistics that incorrectly make it seem as though the demographics of each disease is a match for the other in terms of death statistics.
Statistics matter in the very practical sense of influencing how much money is put into finding a cure or treatment for a certain disease, whatever that disease may be, because it is easier to raise money for a disease that strikes far more people down in the prime of life compared to much later in life, be they men or women. That just makes sense in terms of human nature.
I read it 5 times or more I was so incredulous.
Stats are only important in how one presents them. You should know that. Emphasize this, deemphasize that, and try to make a point.
Bottom line: people are people. A 45 year old woman is not more important to the world than a 65 year old man.
Is your father alive?
A few observations:
-There are more women than men voters.
-all voice menus have female voices.
-One does not hear of ‘watchful waiting’ as a strategy for breast cancer in elderly women.
– Chemotherapy for prostate cancer is toxic, usually futile, and rarely used. Breast cancer is responsive to a wide variety of hormone and chemtherapies.
Don Carlos:
I know cancer treatment is your field of expertise. But I certainly have heard of “watchful waiting” (or rather, non-treatment) in breast cancer of extremely elderly women. I had a relative (by marriage) for whom exactly that was done, for example. It was explained that breast cancer in the very elderly tended to be slow-growing and that she would probably die of something else, whereas the treatment would be more likely to kill or harm her.
I don’t know what’s the cutoff age for treatment would be, or if there is one, but in this case she was very elderly indeed. She did live a few more years, by the way, and I don’t recall that it was the cancer that caused her death.
Here’s a discussion of the issue, by relatives of people who’ve been diagnosed when fairly old.
The question is further complicated by the fact that I couldn’t find any studies that focused on the very old. Most of the studies I’ve seen in a quick Googling about breast cancer treatment and age defined “old” as over 65 or over 70. That’s not what I’m talking about when I say “old,” nor is it similar to the age of the majority of prostate cancer patients, most of whom are older than that. So it’s hard to compare. Do you happen to know how women with breast cancer who are over 85 at diagnosis, for example, tend to be treated? Of whether they tend to be treated?
Another question I have for you is this: if breast cancer treatment has so many more effective treatments than prostate cancer does, why are the overall incidence rates and the overall death rates more or less the same? Are there more treatments that make people more comfortable, or that buy more years of life after diagnosis? Is that the difference?
G Jourbet:
Well, if you read it 5 times, then it’s your reading comprehension and your interpretation that’s the problem.
I suspect you have some emotional investment in this issue related to your friend’s illness, and that might help to account for your unaccustomed and unwarranted attack in this comment of yours. I wish him the best of health, and hope treatment succeeds for him.
G Jourbet,
People are people and gender is and should be irrelevant to society’s perception of worth.
My comment makes clear that I thought neo’s post was perhaps a bit incomplete but I personally detected no ‘reaching’ and I did read it carefully, especially the statistics cited.
Before accusing others of emotional motivation, i.e. ‘reaching’, it’s always wise to first examine ones own premises.
In any case, it’s clear that neo was questioning the imbalance in funding, which makes your question, “Is your father alive?” logically nonsensical and thus indicative of the “emotional investment” neo mentions.
Life without emotion isn’t worth living, life ruled by emotion makes slaves of us.
Actually, in regards to continuation of the species, women are much more valuable than men.
Neo-
I meant ‘watchful waiting’ as a widely recognized, though not universally accepted, medical strategy, not an anecdotal practice. In medicine, when the term ‘watchful waiting’ is used, it is understood as referring to prostate cancer in the elderly, and not to anecdotal other cancer case management examples. The logic is that elderly men often die with, but not of, prostate cancer. The catch is that some (who?) do die of it. It is a population cost-benefit problem.
As to your other queries, it is my bedtime. Sorry!
“Actually, in regards to continuation of the species, women are much more valuable than men.”
On the face of it, that appears to be true. Until you consider the genetic diversity needed for continuation of the species… Both are of equal importance. Vive la différence!
I’m not deep into this, but there are two things I’m aware of which I believe to be true and relevant.
1) The survival rate on breast cancer is exceptionally high for cancers. The survival rate for prostate or testicular (also a largely… LOL… “male dominated” cancer type) are much lower. That is, even once it’s found, the male-oriented cancers are generally much more likely to result in death.
2) When an obviously male-dominated channel like “ESPN” has “Breast cancer awareness month”, with the announcers mentioning the subject every 60 seconds or so to the point where you want to throw a rock at the TV just because of the %#$^#^^ over-the-top endless mention of it like some broken vinyl record, but has NO — repeat NO — similar awareness campaign for even A DAY for either prostate or testicular cancer, that says a lot about our attitudes in society about males in general: “Who gives a fuck?”
Smock Puppet:
You are wrong about the survival rates for the two diseases. Look at the CDC statistics again, from the links provided. The incidence of the diseases are almost identical, and the death rates almost identical. This means the survival rates are nearly identical. The difference is the age of onset and the age of death.
And September is prostate cancer awareness month. What’s more, the “Movember” movement has actually become quite big, especially among young men. I know quite a few who participate. It involves growing a mustache during the month of November to increase awareness of the disease:
Neo:
To pick up from last night, in a less encyclopedic fashion than your estimable posts-
Elderly women have a higher proportion of hormone-receptor(ER,PR) positive cancers, which predict responsiveness to anti-hormone therapy; an 80 year old is already well post menopausal compared to a 40 year old, so toxicity is less an issue.
Oncologists talk in terms of treatment response, not cure. Response may be complete (CR- no demonstrable disease), partial (PR-partial measurable disease response), stable disease (no progression, no shrinkage), or no response ( or progression). The Am Cancer Soc has for decades defined ‘cure’ as no disease for 5 years post diagnosis. But oncologists know that is not a 100% guarantee, since we see the occasional recurrence thereafter; in my case, first recurrence biopsy-confirmed 40 years after 2nd mastectomy.
It is dangerous to generalize about cancer growth rates as a function of age since there is such a broad range of growth rates (tumor doubling times), e.g. 30-210 days. As a general rule, it is better to put out a smaller cancer ‘fire’ when the patient is less infirm than waiting until the fire is bigger and the patient more infirm.
Another reason: vanity. You can’t see a prostate gland.
I’m surprised that prostate cancer kills as many as breast cancer in the end. I thought that breast cancer was often aggressive and needed prompt attention while prostate cancer was less like to be very dangerous quickly. I get my prostate checked yearly and I know older men one 77 the other 85 who have been successfully treated for it. A much younger woman friend has secondaries and is real trouble in her 40s just now. The age is the big difference in my experience. I don’t think it has much to do with Feminism and a lot to do with too many quite young women having their lives significantly shortened.
My wife died of ti at 40. Her mom survived it.
Geoffrey: there’s a reason why we used to save women and children first.
obviously men are very important and genetic diversity is optimal, but there is no comparison to a women’s out-of-commission for 9 months term and a young male’s refractory period.
KLSmith, indeed that is why women in combat makes no sense. Lose a generation of women, see how long it takes for a country to recover. Lose a generation of young men, it is devestating but the recovery is faster.
neo, don’t do an analysis in which you cluster data according to gender and then expect it to be taken as gender neutral (ie, objective).
I really enjoyed the article!
@ Don Carlos said that prostate cancer therapy was usually futile, whereas breast cancer treatment was more responsive. However, breast cancer is funded twice as much as prostate cancer, 600 million to 300 million for the year of 2012. If funding was reversed I’m sure treatment success would be reversed as well.
@ Steve. In some sense you’re right. Women require a 9 month refractory period, and men approximately 15 minutes. However, if we lose a generation of “able men,” who is left to impregnate that generation of women. Simply those ill fit for battle. The men left will be criminals, mentally retarded, the blind (possibly genetic), the asthmatic, and any other “undesirables.” This doesn’t seem like a very promising future either.
@ Trimeistus. You say that vanity is a factor. That beasts are visible and prostates are not. There are bras for those who have had their breasts removed, my grandmother uses them. But, what is one major importance of the prostate, ah yes, the erection. And I think sexual pleasure trumps vanity. There was a Pulitzer Prize winner who had his prostate removed. He said something akin to “I would give up all the awards I have ever recieved for just one more erection.”
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My grandfather lost his prostate and bladder control at 56 and lived until 92 unable to have physical relations or even go a day without smelling of urine; not exactly dignified.
His son, my father, died of the disease quite awfully over just one year at 72.
My other grandfather died without treatment at 72 from other causes.
As a person with a high chance of contracting the cancer I would like to simply say that if you get cancer I hope you have the best care every march or walk or ribbon or donation worn during wear pink days will get you. I certainly will take your logic to heart if my cancer won’t cure me if caught young. My children will certainly not mourn me; after all, what are a few decades? That life wouldn’t really matter.
I read this article, found the facts interesting. One question I have for the author since i didn’t see it in the article is, if breast cancer does get more research funding and awareness because it kills more people at a younger age, do you feel thats the right approach, or or not? I wish they were at least on equal footing as far as funding. (My mom’s a breast cancer survivor (very thankful it got caught early) and my dad got prostate cancer at age 59, thought he had it beat with radiation treatment, though had adverse conditions down there from that point on, then it killed him at age 73.)
RiggoFan44:
Condolences on your loss.
You ask a good, and a tough, question. Fortunately, I’m not the one making that decision. Society has finite resources, and has to decide where best to put them.
That said, here’s my attempt to give my opinion. Research on both diseases needs funding, but when resources are finite, and the numbers dying from each disease are roughly equal, I think it best to give more funding to research on diseases that bring harm to more people who are in the prime of life. That does not mean that older people have no value (in fact, I’m a somewhat older person myself). But it means that when, for example, parents of young children die vs. an older person dying, the tragedy in the first case seems to have higher psychological and societal costs.
Thanks. I actually do agree with you but think of it in a wider view, any disease which kills at a younger age should get looked at and funded aggressively since its impact is greater in society but i do have two observations on prostate cancer awareness which i do find troubling. The first is that it can strike a male far earlier in life (that happened to my dad) then when it finally kills him, so it can cause a number of health issues that are crippling to a man like incontinence and impotence. Not all prostate cancer patients have this but many, many do. But I rarely hear that in the news, all i’ll I usually hear is it kills old men. So it can have an impact on alot more middle age men then people realize. As a 51 year old male myself who has alot of prostate cancer in my family thats kind of scary. The second observation is when you compare the coverage that breast cancer gets compared to prostate cancer as far as awareness campaigns, it seems to favor breast cancer by a factor far, far greater then even the funding difference. It seems like I see 40-50 adds for breast cancer for each one I see for prostate cancer (can’t even remember the last time i saw one) and the NFL is a prime example, your bombarded with pink at every NFL game you watch right now and you know its Breast Cancer awareness month (which i support fully) but you wouldn’t have known the month before that September was Prostate Cancer awareness month, the NFL didn’t say a word or have any awareness programs. Something is wrong there. I just think for a modest cost they can ramp up prostate awareness (which would increase donations) but for some reason they don’t do that. That bothers me.
Again, thanks and have a great day.
Correction: I did find that the NFL does have a prostate awareness program called “know your numbers” but I had to dig in the internet to find it and I’ve never seen it mentioned during an NFL game. They should give it alot more visibility, i shouldn’t have to dig in the internet to find it.
RiggoFan44:
You’re correct that quality of life is a factor, in addition to mortality. I’ve read a lot about doctors trying to improve prostate cancer treatment to avoid those problems as much as possible, but there’s no question that there are such problems and they can be severe with prostate cancer.