The sounds of silence

I was diagnosed with prostate cancer in December of 2004. I was 46 at the time. After my diagnosis I talked openly about my prostate cancer. I found that guys just didn't seem to feel comfortable talking about prostates and testing. I worked as a FireFighter for just over 20 years and had always noticed that fact at work. Because of that, and the fact that prostate cancer seems to be more prevalent amongst FireFighters, I rode across Canada to try to raise awareness and to get guys to talk about the disease.

I really appreciate your article. It is something my wife and I have talked about extensively. We always see and hear about breast cancer (which is great), but we do need to do the same for prostate cancer.

I will keep trying to convince the men I talk to, to talk openly about prostate cancer, testing and the importance of early detection.

Thanks so much for bringing these facts to the forefront.

While I recognize that breast cancer has an earlier average age of onset than does prostate cancer, it would seem unfair if women's higher life expectancy were to be taken into consideration when calculating potential years of life lost (pyll). Should men be penalized, or prostate cancer be regarded as less devastating than breast cancer, because men as a group are already penalized by shorter average life expectancy than women? A ratio of pyll to average life span would seem more appropriate in calculating the relative impact.

I hope that if the pyll calculation is used as a factor in determining relative need or the merits of funding or research that men will not be at a further disadvantage because of women's greater longevity.

Let's talk about prostate and breast cancer:great. But let's talk longer and louder about osteoporosis, the complications of which kill more Canadian men than prostate cancer and more Canadian women than breast, uterine and ovarian cancers combined. Patients with these complications (notably fractures) also tie up operating rooms, lengthen wait times for elective orthopedic procedures, occupy acute care beds waiting for admission to homes for special care, and occupy nursing home beds.

Most of these complications are preventable. Bone mineral density measurement provides accurate diagnosis. Safe, cheap and effective medication is available - fracture risk is reduced between fifty and sixty -five per cent in the first year.

In Nova Scotia, hip fractures occur at an average of two per day. The cause of this high rate is multifactorial, but surely a significant factor is lack of knowledge of the disease. It's entirely likely that most people with osteoporosis don't know they have it - until disaster strikes.

We need to make more noise about osteoporosis: our profession, departments of health, Osteoporosis Canada. Yet how many family doctors, particularly when confronted by a senior with multiple problems, have either the time or the mindset to talk about bone densitometry.

So let's talk about osteoporosis along with breast and prostate cancer - it's a worse killer than either of them.

Thank you for your letter. There are potentially many factors contributing to the difference in impact between breast cancer and prostate cancer. I agree that potential years of life lost (PYLL) can be a major factor in this difference, reflecting the later average age at initial diagnosis in prostate cancer and the aggressivity of breast cancer that can occur particularly in younger women.

The PYLL for female breast cancer deaths (rate per 100,000) in Canadian women between 0-74 years of age in 2001 (based on a three year average) was 334.5 (1). The PYLL for prostate cancer deaths over the same time period was 56.6 (2).

1. http://www.statcan.ca/english/freepub/82-221- XIE/2007001/maps/dt_maps/de1pyo2c.pdf (accessed February 15, 2008)

2. http://www.statcan.ca/english/freepub/82-221- XIE/2007001/maps/dt_maps/de1pyo2d.pdf (accessed February 15, 2008)