Dry, cracked skin formed a small crater around exposed flesh at the base of my fiancÃ© Noel's pinkie.
"How long have you had that?" I asked him.
"A few days," he answered, speculating it was probably just an outbreak of eczema.
"That doesn't look good," I replied. "Maybe you should see your doctor."
"OK," he said. I shook my head, knowing it would be a while before he heeded my suggestion. Last year, it took a few months to convince him to go for a physical examination. Before that, it had been five years since he'd been to a doctor.
To Noel's credit, he's just being a guy. According to a 2001 CDC report, women are 33% more likely than men to visit a doctor in general, although the gap narrows with increasing age.
One could accept the statistic as just another difference between men and women, but the stakes are too high to remain complacent.
The Men's Health Network (MHN) reports that men die at higher rates than women from the top 10 causes of death - heart disease, cancer, stroke, chronic obstructive pulmonary disease, accidents, pneumonia and influenza, diabetes, suicide, kidney disease, and chronic liver disease and cirrhosis.
Men also die younger than women. In 1920, women outlived men only by one year. Today, CDC figures show the life expectancy gap has widened: On average, women survive men by over five years.
"Any human being who is not connected to a physician to screen for major health problems is at greater risk (of disease and death)," says Jean Bonhomme, MD, MPH, a board member of the MHN.
The biggest problem that men have is not so much a specific disease, says Bonhomme, but the diseases are the result of lack of health care monitoring earlier in life. He cites the progression of heart disease as an example: "If you don't get your cholesterol checked when it's going high when you're 20, and if don't get your blood pressure checked when it's going high when you're 30, maybe your blood sugar's getting a little high when you're 40, what do you think is going to happen when you're 50?"
Bonhomme places part of the blame on society in general, which expects boys to be tough and ignore pain. As people get older, however, the rules change. A little pain can get worse, or signal something more serious going on in the body.
Many of the top 10 causes of death are preventable, and can be treated, if found early. To help men better their health, WebMD examined the risk factors for five of the biggest killers of men: heart disease, stroke, suicide, prostate cancer, and lung cancer. We asked the experts why men were so vulnerable to these ailments and what they could do to reduce their risk of disease and death.
Although heart disease is the leading killer of both men and women, almost twice as many males die of conditions that affect the cardiovascular system, the MHN reports.
According to the CDC, one in four men has some form of heart disease. It is the leading cause of death.
Average annual rates of the first heart disease complication rises from seven per 1,000 men at ages 35-44 to 68 per 1,000 at ages 85-94. For women, similar rates occur but they happen about 10 years later in life. The average age of a person having a first heart attack is 65.8 for men and 70.4 for women.
"For men, heart disease begins to manifest itself about 10 years earlier than women," says Gregory Burke, MD, professor and chairman of the department of public health sciences at the Wake Forest University School of Medicine.
This does not mean men have a free pass against heart disease until they're older. Men have a shorter time to prevent the development of the condition so their overall risk is greater.
According to the American Heart Association (AHA), risk factors for heart disease include:
- Increasing age
- Male sex
- Family history and race.Folks with family history of the disease have greater risk. So do African-Americans, Mexican Americans,
- Native Americans, Native Hawaiians, and some Asian Americans.
- High blood cholesterol
- High blood pressure
- Physical inactivity
- Obesity and overweight
Stroke is the third leading killer in the country, after heart disease and all forms of cancer. The incidence rate of stroke is 1.25 times greater in men than in women, although there is really no difference between the sexes as people get older, according to the American Stroke Association.
Other risk factors include:
- Increasing age
- Race. African-Americans have the greater risk than whites.
- Gender. Stroke is more common in men than in women until age 75.
- Personal history of stroke or a transient ischemic attack (TIA, or ministroke)
- High cholesterol
- Heart disease
- Smoking, including secondhand smoke
- Physical inactivity
- Alcohol and substance abuse
In many ways, behaviors that can reduce the risk of stroke mirror those that can reduce risk of heart disease. "We need to recognize that a healthy lifestyle -- dietary factors and exercise -- reduces the risk of people getting hypertension at all," says Burke.
"It happens more commonly in the older folks, but it should never be viewed as inevitable, even in people with a family history of the disease," says Burke.
Suicide and Depression
Men are four times more likely to commit suicide compared to women, reports the MHN, which attributes part of the blame on underdiagnosed depression in men.
William Pollack, PhD, assistant clinical professor of psychiatry at Harvard Medical School, agrees: "Men are more prone to suicide because they're less likely to openly show depression and have somebody else recognize it early enough to treat it, or to have themselves recognize that they're in trouble."
According to the National Institute of Mental Health, more than 6 million men have depression each year. Pollack believes the number of males with depression could be even greater since men may show signs of depression in a manner different from many women.
Instead of sadness, Pollack says depression may play out in the following ways in men:
- Work "burnout"
- Risk-taking behavior
- Midlife crisis
- Alcohol and substance abuse
"Society around the men and the men themselves see (the male symptoms of depression) as 'just being a guy,' or 'having a hard time,'" says Pollack. "The problem is that if they are signs of depression, and they're getting bad enough, then many of these men are starting to form thoughts that life isn't worth living."
To help men with depression and to reduce the risk of suicide, doctors, loved ones, and men themselves need to recognize that society's model of masculinity -- to ignore pain --can work against men. Looking the other way may trigger depression and thoughts of suicide.
Lung cancer is the leading cancer killer of both men and women, claiming more lives than prostate, colon, and breast cancer combined. In men, there are expected to be about 213, 380 new cases of lung cancer and some 160,390 lung cancer deaths this year.
The good news is that rate of new lung cancer cases has been dropping since the 1980s, and deaths from the cancer have fallen since the 1990s. "That is because of the drop in the prevalence of the use of tobacco products by men that followed the Surgeon General's report in 1964," explains Sener.
Besides smoking, the ACS lists the following as risk factors for lung cancer:
- Exposure to secondhand smoke
- Exposure to asbestos or radon
- Personal history
- Air pollution
Tobacco products are responsible for 90% of lung cancer, which puts the weight of prevention efforts on smoking cessation.
If you're thinking about kicking the habit, Sener recommends the following resources:
- American Cancer Society: (800) ACS-2345
- National Cancer Institute Smoking Quitline: (877) 44U-QUIT
Prostate cancer is the most common cancer found in men. It is the second leading type of cancer death in men, after lung cancer.
There is not enough known about what causes prostate cancer and how to prevent it. Yet the disease is treatable if found in early stages. This can be a challenge, since prostate cancer can show no symptoms until it has spread to other parts of the body.
This is where a connection to the doctor helps, says Bonhomme. "I personally know people who are alive today because they got (prostate cancer) screening."
The American Cancer Society (ACS) recommends a prostate-specific antigen (PSA) blood test and digital rectal exam be offered annually for healthy men starting at age 50 or older. Men who are at high risk -- such as those who have family history of prostate cancer or who are black -- should begin testing earlier.
According to the ACS, other risk factors include:
- Increasing age
- Nationality. The cancer is most common in North America and Northwestern Europe.
- High-fat diet. Men who eat a lot of red meat and high-fat dairy products and not enough fruits and vegetables may have a higher risk.
Although older age is a risk factor for prostate cancer, younger men should not be complacent. Thirty percent of prostate cancers occur in men under age 65. "The younger a man is, the more aggressive the tumor is," says Stephen F. Sener, MD, ACS president.