What Prostate Cancer Stakeholders Can Learn from Breast Cancer

When it comes to health promotion and advocacy, the breast cancer community’s efforts, through decades of sustained action, have resulted in remarkable gains in levels of awareness, education and funding. The ubiquitous pink ribbons, high-profile charity fundraiser events, and sports teams wearing pink each October in recognition of Breast Cancer Awareness Month are just a few supporting examples.

We applaud the breast cancer awareness movement for the important progress it has made and all the insights it has shared with other disciplines. Those insights, built on tireless effort, offer guidance to other movements including the prostate cancer community.

Two cancers with similar characteristics

Breast and prostate cancer share many things in common, which lead to similar advocacy needs:

• They are the second most common types of cancer and cancer deaths in the U.S. among women and men, respectively.
• Incidence rates are highly comparable, with about 298,000 cases of breast cancer projected in 2023, compared with 288,000 for prostate cancer. That translates to about one in eight women diagnosed in their lifetime — the same rate for men with prostate cancer.
• So are fatalities, which are projected for 2023 to be around 43,000 and 34,700, respectively.
• The two types of cancer share many of the same risk factors, including having a first-degree relative with the disease, being overweight, physical inactivity, consuming alcohol and having certain chronic diseases such as diabetes.
• There’s even a genetic link between breast and prostate cancers, with evidence that a family history of breast cancer may increase a man’s risk of getting prostate cancer. Mutations in the BRCA1 and BRCA2 genes shared by both men and women are known to increase the risk of breast cancer in women and of prostate cancer in men. Genetic mutations are thought to make up 5-10% of both types of cancer.
• Early detection is critical for both types of cancer. For breast cancer, the five-year survival rate is 90% or greater for all subtypes when detected early and the cancer is localized. That compares to a nearly 100% five-year survival rate for men when prostate cancer is diagnosed in its earliest stages.
• Just like with prostate cancer, there are racial disparities in breast cancer, where Black women face a 40% higher death rate than white women despite having a lower incidence rate. Black women are also likely to be diagnosed with breast cancer at a younger age.

Breast cancer community’s impact

Breast cancer’s high profile is partly due to how common it is, comprising one in three new cases of cancer in women each year. Given that high prevalence, the breast cancer advocacy movement has worked hard to save lives: Deaths from breast cancer have fallen 43% since peaking in 1989, thanks largely to early detection, improvements in treatment and greater awareness of the disease.

Today, you’d be hard-pressed to find a primary care physician or OB-GYN who doesn’t openly discuss breast cancer risk factors with their female patients and urge them to get screened. Women talk about the subject with each other. Mothers plead with their daughters to get a mammogram. People have achieved a level of comfort in openly discussing a condition that affects women’s private parts.

Prostate cancer wins and challenges

The prostate cancer awareness movement can also point to similar clinical successes. Deaths dropped by half from 1993 to 2013 thanks to advances in screening and treatment. But the decline has since slowed drastically. Physicians are diagnosing more prostate cancers at an advanced stage, which suggests that fewer men are getting regular screenings.

Prostate cancer screenings are recommended for men at higher demographic risk starting in their 40s. However, barriers remain – lack of awareness, fear and stigma, challenging doctor-patient communication, lack of access to care and/or high costs. This underscores the important efforts of the prostate cancer community in uniting clinicians, patients and the greater community to break down these barriers.

Prostate cancer is notorious for being difficult to detect — it often presents no symptoms in its early stages, and PSA levels on their own paint an incomplete picture — and slow-growing. Guidance about when to recommend screening has been inconsistent over time. As a result, some physicians are reluctant to intervene or even refer patients with high PSA scores to a urologist for further examination, as the path forward is unclear

Communication differences

Men would do well to achieve the same level of comfort talking about prostate cancer that women have discussing breast cancer. Historically this has been challenging. Studies show that men are often not comfortable discussing their health challenges, use fewer preventive services than women, and are more reluctant to seek immediate treatment for their conditions. It may partly explain why the life expectancy gap between men and women is the highest in decades.

Community efforts show promise

Thankfully, there is truly excellent national level and more regionally based work underway to support men and broaden awareness of prostate cancer, similar to breast cancer.

Movember deserves major credit for its fundraising for research and its efforts to make mustaches the symbol of prostate cancer awareness (though the organization also focuses on testicular cancer and other men’s health issues). Movember also funds the excellent True North program, which offers invaluable resources and information for men who have prostate cancer. ZERO is partnering with well-known public figures and sponsors many nationally advertised walks to raise awareness throughout the country.

Enlisting help from existing community groups has also proven effective for increasing awareness and screening rates. Enlisting Black barbers in the cause has also proved effective in broadening awareness among a key population at higher risk for the disease. Barbers for Health, one such group in the Boston area, has become a model for recruiting community institutions to the cause.

Prostate cancer incidence and death rates remain concerning, and we applaud all stakeholders who are striving to raise money and increase awareness, access to care and support in an effort to bring them down. We thank the breast cancer movement for the valuable lessons it gives.