Last week, Buckingham Palace made a startling announcement regarding King Charles III's cancer diagnosis, sending shockwaves across the country. As we went to press on Tuesday 13 January, King Charles reached London from their private Sandringham house to continue his cancer treatment. While the community rallied behind the King with him thanking the public for support, revelation sparked widespread speculation about the future of the monarchy, particularly due to the unprecedented nature of publicly disclosing the monarch's ailment. Historically, such health matters were kept private, making this announcement a significant departure from tradition.
Beyond the initial uproar, the announcement triggered a surge in health awareness among the public. On 18 January, after it was announced that the King was to undergo a “corrective procedure” for a benign enlarged prostate, NHS England reported a remarkable increase in visits to an NHS webpage offering guidance on prostate enlargement. The day saw a staggering 1,061% rise, with 16,410 visits compared to just 1,414 visits the previous day.
Moreover, various cancer charities also noticed a surge in website traffic following King Charles's disclosure of his cancer diagnosis. Prostate Cancer UK, for instance, reported a fivefold increase in website visitors, with a notable uptick in men using the online risk checker to determine if they should undergo a prostate checkup.
Speaking about King Charles’ recent diagnosis and the conversation sparked by the event, Mark Guymer, CEO of Cancer Support UK said, “Without doubt, the recent diagnosis has helped raise awareness of male cancer and how early detection improves the success of treatment and chances of survival. The King’s openness about his cancer emphasises the importance of early diagnosis and also signals a clear message that it’s okay to talk about cancer. The news about the Royal cancer will prompt people to search for information about cancer types, treatments and preventative steps, like routine screenings and to reach out for support. We know that lived experience stories are a powerful way to reach male target audiences who can identify with personal journeys.
“The diagnosis also shows that cancer can affect anyone – rich or poor, old and young, male or female and underlines the fact that no one deserves cancer or should be judged because of their diagnosis.”
In 2020, England recorded 288,753 new cases of cancer, with a 21% higher overall incidence rate in men compared to women. Presently, approximately 250,000 men are living with cancer across the UK, according to Macmillan's latest research. Prostate Cancer UK reports that, on average, more than 52,000 men are diagnosed with prostate cancer annually. This translates to approximately 144 new diagnoses per day. Alarmingly, every 45 minutes, one man succumbs to prostate cancer, resulting in over 12,000 deaths each year.
With statistics like this, it has become imperative that conversation about cancer in British Asians, is initiated and aspects like culturally appropriate emotional support, barriers, stigma, early diagnosis, state of cancer care in Britain and awareness about the disease are discussed on public platforms.
Self-examination to aid cancer diagnosis
According to Prasanna Sooriakumaran, a Professor and Chair of Urology, and Consultant Urological and Robotic Surgeon at Cleveland Clinic, London, the most common cancer affecting young men in their 20s and 30s is testicular cancer and that affecting older men (50s and above) is prostate cancer.
One of the main problems with both testicular and prostate cancer awareness is these organs are generally considered the “private parts” that men don’t want to discuss or talk about. This is especially true among Asian communities where there is good awareness generally of heart disease, diabetes, obesity, etc. but very little awareness of male cancers. “I feel engaging Asian men with these “taboo” topics is key to raising awareness and saving lives”, Prof Sooriakumaran said.
The problem with both testicular cancer and prostate cancer is they are without symptoms in their early, curative stages, it is mostly in the genes. Prof Sooriakumaran describes the best way to spot testicular cancer early is through testicular self-examination. Luckily, testicular cancer is usually only on one side so if one testis feels different to the other (e.g. you feel a lump on one side that isn’t there on the other) then you need to see a urologist for an examination and ultrasound scan.
With prostate cancer, there are no symptoms either in its early stages. The best way therefore of picking it up is with a blood test called a PSA (prostate-specific antigen), followed by an MRI scan of the prostate if the PSA is raised. This might then lead to a biopsy of the prostate to give a diagnosis of cancer. Again, men need to be proactive with regular PSA checks from their 50s and see a urologist if the PSA is ever raised.
According to Dr Arjun Ghosh, a Consultant Cardiologist at UCLH and Barts Heart Centre working to grow cardio-oncology services, “Persistent changes in urinary symptoms or bowel habits should not be disregarded, just as seeking medical advice is crucial for a new, persistent cough.
“I believe there should be increased educational outreach efforts at community centres or community events to raise awareness about cancer screening and check-ups.”
Other common cancers in men are lung, bowel and bladder cancer. Risk factors include an underlying genetic predisposition and in some cases external factors such as smoking, diet, weight and exercise.
Barriers and taboo facing men with cancer
Cancer can have a profound impact on masculine identity, and can affect men in many ways:
- Physically ( hair and muscle loss, fatigue (tiredness), incontinence)
- Sexually (reduced sexual drive and impotence),
- Economically (the ability to act as a provider/protector of the family)
- Emotionally (negative self-image, low self-esteem, isolation, anxiety, depression, mood swings)
About key challenges or barriers faced by men when it comes to cancer awareness and seeking support, Mark Guymer, CEO of Cancer Support UK shared that men with cancer face gender discrimination, as well as societal and cultural taboos. He said, “Side effects of cancer in particular can be very distressing for men, resulting in social stigmatisation, which can be difficult to handle. It can result in feelings of shame, hopelessness and isolation. Consequently, they are reluctant to ask for help and even get treatment. Stigma can even discourage men from attending cancer screening.”
Mark also noted that men are notably reluctant to talk about personal emotional issues, unsurprisingly due to unsurprising societal pressure of bravery and emotional stoicism. Because men aren’t encouraged to talk about their feelings as much as women, it is a challenge for them to communicate, made even harder owing to peer pressure, a sense of self-reliance and the sensitivity of some cancers, such as testicular cancer or prostate cancer.
The latest research by Macmillan Cancer Support found that 19% of men living with cancer struggle with feelings of sadness or depression, or worry, fear and anxiety, but despite this more than half (55%) of those who are affected have not yet sought any support for their feelings.
Sian Robison-Brown, Service Knowledge Specialist at Macmillan Cancer Support, said “Unfortunately, there is still a societal taboo around cancer and while men represent 52% of cancer cases, only 38% of the calls to our Macmillan Support Line come from men. This means men are missing out on getting the support they need. We need to get more men talking about cancer and seeking support.”
Between 1st January 2022 to 31st December 2022, Macmillan Support Line directly supported an estimate of 37,997 females with cancer, 22,810 males with cancer and 1,698 people with cancer for whom a gender was not recorded.
According to Prof Sooriakumaran, the main barriers that prevent men from seeking medical help or discussing their health concerns is themselves. “The stereotypical Asian male feels he cannot show any sign of weakness and thus tends to ignore any health issues and carry on. Plus, the stigma of discussing cancers of the private parts makes this worse. Men need to realise that these cancers are common and getting more so in the Asian community and the best way to deal with them effectively is to diagnose them early”, he said.
Need for better culturally sensitive and appropriate support
South Asian Health Action UK (SAHA UK) is a charity and a delivery partner for NHS Leicester, Leicestershire and Rutland on the NHS Core 20 Plus 5 Health Inequalities Project which is focused on early cancer diagnosis and screening and recruitment of community connectors with lived experience to help raise awareness, address stigma and taboo within South Asian communities.
Kirit Mistry founded SAHA UK due to the lack of South Asian patient support, care and community voices to help shape better culturally sensitive and appropriate services. He said, “In my experience, breaking down taboos and stigmas surrounding cancer in men, particularly within cultures or communities where health discussions are considered taboo, requires multifaceted approaches and is culturally sensitive.
“Initiatives like Core20Plus5, a collaboration between South Asian Health Action and the NHS, play a crucial role in raising awareness about early diagnosis and treatment options, especially within the South Asian community. By fostering dialogue, providing education, and destigmatising conversations around cancer, we can empower individuals to prioritise their health and seek timely intervention.”
Kirit believes that dispelling misconceptions and myths surrounding cancer in men is crucial in fostering informed decision-making and proactive health-seeking behaviours. Organisations must engage in targeted educational campaigns to address misunderstandings and promote accurate information about risk factors, symptoms, and available treatments.
SAHA is currently seeking funding to develop a South Asian-specific men's Cancer support group for men who do not speak up or seek help due to not wanting to show their weakness.
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Emotional support goes a long way
Families and support networks must play an active role in supporting men affected by cancer. By offering emotional support, practical assistance, and advocating for access to resources and treatment options, loved ones can make a profound difference in the lives of those facing cancer.
Through SAHA UK, Keval Sachdev, a 43-year-old British Indian man shared his journey with cancer, stating, “My journey with cancer has been both challenging and eye-opening. Diagnosed with Aggressive Lymphoma in 2022, I was late diagnosed and embarked on a tumultuous path of treatments, including six months of chemotherapy, and continue to navigate the complexities of ongoing monitoring and care.”
He said, "Reflecting on my journey, I've come to recognise the significant barriers men face in cancer awareness, prevention, and early detection. Societal perceptions and stereotypes around masculinity often inhibit men from seeking help or discussing their health experiences openly. The stigma associated with vulnerability and illness creates a barrier to accessing timely care and support.”
“My personal support network, comprised of family, friends, the dedicated team at Leicester Royal Infirmary Hospital, and the invaluable resources offered by organisations like South Asian Health Action, has been instrumental in navigating the complexities of my cancer journey, being a source of strength during my most challenging moments".
Keval says his journey with cancer has been defined by resilience, community support, and a commitment to raising awareness and breaking down barriers. “Through collective action and empathy, we can empower men to prioritise their health, seek support without shame, and ultimately, navigate their cancer journey with courage and dignity”, he said.
