May 29th, 2013

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.

33 Responses to “Prostate vs. breast cancer”

  1. KLSmith Says:

    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.

  2. neo-neocon Says:

    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:

    Breast cancer is the leading cancer killer among women aged 20–59 years in high-income countries.

    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.

  3. GLEN Says:

    IT is helpful to read this classic article on the subject in order to have a more informed basis for discussion.

  4. DJMoore Says:

    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.)

  5. neo-neocon Says:

    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:

    A rational, nonpolitical explanation for this is that breast cancer attacks a larger number of patients, at a younger age.

    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.

  6. neo-neocon Says:

    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.

  7. Geoffrey Britain Says:

    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.

  8. holmes Says:

    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.

  9. neo-neocon Says:


    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:

    Men with BRCA mutations cannot get ovarian cancer, but they may be twice as likely as non-carriers to develop prostate cancer at a younger age. The risk is smaller and disputed for BRCA1 carriers; up to one-third of BRCA2 mutation carriers are expected to develop prostate cancer before age 65. Prostate cancer in BRCA mutation carriers tends to appear a decade earlier than normal, and it tends to be more aggressive than normal. As a result, annual prostate screening, including a digital rectal examination, is appropriate at age 40 among known carriers, rather than age 50.

  10. bob r Says:

    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.

  11. expat Says:

    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.

  12. Jim Nicholas Says:

    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.

    Another significant issue–not dealt with in the above link–is the quality of life between first symptoms, diagnosis, and death.

  13. G Joubert Says:

    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.

  14. neo-neocon Says:

    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.

  15. G Joubert Says:

    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?

  16. Don Carlos Says:

    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.

  17. neo-neocon Says:

    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?

  18. neo-neocon Says:

    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.

  19. Geoffrey Britain Says:

    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.

  20. KLSmith Says:

    Actually, in regards to continuation of the species, women are much more valuable than men.

  21. Don Carlos Says:

    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!

  22. Geoffrey Britain Says:

    “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!

  23. Smock Puppet, Gadfy, Racist-Sexist Thug, and Bon Vivant All In One Package Says:

    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?”

  24. neo-neocon Says:

    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:

    The Movember Foundation runs the Movember charity event, housed at The goal of Movember is to “change the face of men’s health.”

    By encouraging men (which the charity refers to as “Mo Bros”) to get involved, Movember aims to increase early cancer detection, diagnosis and effective treatments, and ultimately reduce the number of preventable deaths. Besides getting an annual check-up, the Movember Foundation encourages men to be aware of any family history of cancer, and to adopt a healthier lifestyle.

    Since 2004, the Movember Foundation charity has run Movember events to raise awareness and funds for men’s health issues, such as prostate cancer and depression, in Australia and New Zealand. In 2007, events were launched in Ireland, Canada, Czech Republic, Denmark, El Salvador, Spain, the United Kingdom, Israel, South Africa, Taiwan, and the United States.

    It has spread from Australia to South Africa, Europe, and North America. As of 2011 Canadians were the largest contributors to the Movember charities of any nation. In 2010, Movember merged with the testicular cancer event Tacheback.

    In 2012 the Global Journal listed Movember as one of the top 100 NGOs (non government organization) in the world

  25. Don Carlos Says:

    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.

  26. Trimegistus Says:

    Another reason: vanity. You can’t see a prostate gland.

  27. Lorenz Gude Says:

    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.

  28. Sam L. Says:

    My wife died of ti at 40. Her mom survived it.

  29. KLSmith Says:

    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.

  30. Steve Says:

    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).

  31. Metallic Says:

    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.

  32. Metallic Says:

    @ 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.”

  33. Orthomol название витаминов Says:

    алфавит витамины отзывы

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