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With men two-thirds more likely to die from non-gender specific cancers than women, new approaches to preventing cancer in men are needed, argues the Men's Health Forum

THE REASON WHY MEN have higher rates of death and poorer outcomes from cancer than women is to do with lifestyle differences between the sexes, according to a report from the Men's Health Forum. 'Men and Cancer: Saving Lives' calls for lifestyle advice, health information, symptom awareness and screening to be targeted more effectively at men, particularly those men who are least likely to visit primary care services. Pharmacy is ideally placed to reach out to men to deliver these services, says the patient charity.

Reasons behind the gender gap

Data about men's lifestyles collated by the Men's Health Forum show that men generally have a poorer diet than women and are less knowledgeable about healthy foods. They are slightly more likely to smoke cigarettes and to smoke more cigarettes each day. They are also more likely than women to drink alcohol and to drink at levels that are hazardous for health €“ all risk factors for several types of cancer.

While men are more likely than women to have more physically active lifestyles, over half of men do not exercise at recommended levels and one-third of men are sedentary.

Alan White, professor of men's health at Leeds Beckett University and chair of the Men's Health Forum board of trustees, says men generally do not take lifestyle messages on board. €For example, a lot of men have no idea of the implications of being overweight and often do not even realise that they are overweight. They look around and think it is normal because everyone has got middle aged spread, missing the fact that they are likely to have visceral fat building up around their organs. This will be having a negative impact on their cardiac and metabolic health and will be increasing their risk of fat-related cancers.€

The other part of the story is to do with the male psyche and a tendency for men to hide their heads in the sand when it comes to health issues.

Throughout their lives women tend to have frequent contact with pharmacists and other health professionals when seeking contraception or during pregnancy and when raising children. While there are a number of publications aimed at male health and fitness, health messages for men have not reached the saturation they have achieved in the female media market.

Low awareness of risk factors

The 'Men and Cancer' report says that men are less likely to be aware of cancer risk factors and symptoms and so less likely to get an early diagnosis that could save their lives. Other reasons men cite which deter them from seeking medical help include feeling embarrassed talking about sexual areas of the body, fear of loss of sexuality after treatment, seeing seeking help as unmasculine and not wanting to appear €neurotic€.

€Men can be deterred from visiting health services because of issues of loss of face and feelings of shame for wasting people's time, embarrassment, and not being as aware of how to make an anxiety verbal,€ says Professor White. Martin Tod, chief executive of the Men's Health Forum, also points out that, €because men are more likely to be working full-time, they use the health system less and that holds them back from engaging with it€.

How men use primary care

Researchcollated by the Men's Health Forum shows that men are less likely than women to use general practice or visit a pharmacy. In England in 2008/9, general practice consultation rates for females were higher than those for males except for the extremes of age (i.e. the very young and the very elderly). The biggest difference between men and women was in the 20-40-year age group, where women attended general practice twice as often.

There is evidence that men do not delay seeking help longer than women for some health problems, such as back pain and headaches, but that they do for others e.g. malignant melanoma, lung cancer, and bladder and other urological cancers.

According to National Pharmacy Association research, men on average visit a pharmacy four times a year, while the average for women is 18 times a year. A third of men get their partner to collect their prescription medicines, which means they're less likely to have a face-to-face discussion with pharmacy teams and to benefit from lifestyle advice.

Another report by the Men's Health Forum called 'Racks of makeup and no spanners', investigating men's use of pharmacy, found that community pharmacies have not fully developed their potential to offer health information, advice and guidance for self-care €“ and are significantly underused by men. This is in spite of pharmacies having many of the characteristics that men look for in a service, such as accessibility, flexibility and informality.

Men thought the public nature of the pharmacy 'space' was more suited to the way that women communicate. There was a consensus that if men were seeking health advice, they would prefer to go to a doctor. This was partly attributable to a lack of knowledge about the pharmacist and the team's role and training.

How pharmacy can engage with men

€We need to work a lot harder to make pharmacies relevant to men,€ says Graham Phillips, owner of Manor Pharmacy Group, Hertfordshire, who has a special interest in men's health. €In my pharmacy we found that when we did a football-themed window we got more men in, creating an opportunity to talk about their health. The pharmacy is generally a feminised environment, which does not make men feel comfortable. If you can introduce some male healthtype messages it doesn't solve the problem €“ but it helps.€

Graham has for some time been campaigning for Viagra and other ED drugs to become Pharmacy-only medicines. €This would be one of the best things that could improve pharmacy's engagement with men,€ he argues. €Most men who struggle to maintain an erection have a very high cardiovascular risk. If we can get men into the pharmacy to talk about their erections, then this would be an opportunity for the pharmacist to talk in greater depth about their health at the same time.€

Graham believes that pharmacists can individually help men improve their health by encouraging them to make small changes, such as improving their diet or taking up exercise. He is currently involved in setting up an intervention research study with the University of Surrey to investigate whether men given hormone treatment post-resection of the prostate can add years to their lives by making these simple lifestyle improvements with the help of a pharmacist.

Another way that pharmacies could engage with men is by handing out leaflets on health issues relating to men. Although a small initiative, when multiplied by over 13,000 UK pharmacies it could have a significant impact. €Each of us needs to do our bit because together it all adds up. Small awareness-raising collectively could make a huge difference,€ he says.

Graham has also been pushing for vascular health checks in pharmacy to be heavily targeted at men, supplemented with clear advice on the 10-year health risks of continuing to smoke and drink plus support with diet, exercise and smoking cessation. €Health checks done properly in the pharmacy with the right marketing and some NHS support could be a huge leap forward for men's health,€ he says.

Martin Tod says the Men's Health Forum is encouraging the NHS to do a better job of getting health checks out to men. There is anecdotal evidence that healthy living pharmacies are having some success in this area. MURs are another opportunity to engage men, particularly older men, and discuss issues that are relevant for this age group, such as prostate awareness.

Men purchasing products can also offer an ideal opportunity for wider discussions about their health. In particular men buying nicotine replacement therapies are an opportunity to offer smoking cessation support and could be a route into discussing alcohol and other health-related issues.

Pharmacists should also make an effort to understand the barriers that prevent men using their services. Professor White says that when most men join weight loss programmes, they tend to do very well €“ so the key is to organise sessions that suit men. €We find that men-only weight loss groups are very effective. Also those held in the evening as opposed to during the day are attractive to men. This is something pharmacists could think about.€

Nigel Hughes, public health specialist at Community Pharmacy West Yorkshire, believes pharmacists could have an impact on men's health by going out to men's workplaces, community venues, and educational and sports establishments, or become involved in promoting workplace initiatives that deliver health information and advice. This would require them to work in non-traditional ways and outside the pharmacy.

Last year, as part of Ask Your Pharmacist Week, Community Pharmacy West Yorkshire visited venues where men would be present in significant numbers and gave out cards promoting pharmacy services. €On one match day at Leeds United football ground we gave out 7,500 cards. We spent a couple of hours there on a Saturday afternoon and had lots of conversations,€ Nigel says.

Men on average visit a pharmacy four times a year, while the average for women is 18 times a year

Reaching men through technology

€Men love having tests of some kind that are free, so offer them a cholesterol test or blood pressure check,€ says Jane Deville-Almond, senior nurse lecturer with a special interest in men's health at the University of Wolverhampton. €Then when you have got them in, you can talk about other clinical areas, such as losing weight or stopping smoking, and tell them how you can help them.€

Martin Tod agrees that technology is one way that pharmacists could encourage men to take better care of their health. €Men love gadgets. There is, for example, some evidence that pedometers work particularly well to help men lose weight by encouraging them to increase their levels of activity. The increasing popularity of wearable health technology that measures things like pulse, heart rate and blood pressure, and encourages the wearer to set fitness goals, is something men are likely to respond to. Pharmacists could develop a health gadget section, which they direct men to after doing their health check.€

Graham Phillips says a male NHS health app on a smart phone could be a very effective way of delivering health messages to men. €Pharmacists could promote it and integrate with it to encourage self-motivation and incremental lifestyle changes that could be so effective in improving men's health.€

Common conditions affecting men

Hair loss

Male pattern baldness is the commonest type of hair loss affecting 6.5m men in the UK. It is an inherited condition and is a natural part of ageing. Some men may seek treatment for cosmetic reasons. Two drugs used to treat the condition are minoxidil, which is sold over the counter as Regaine, and finasteride, which needs a private prescription.

Maintenance products including shampoos, hair loss concealers, hair nutrition vitamins and supplements are also available. Other treatments that can be recommended by specialists include wigs, hair transplants and plastic surgery procedures such as scalp flaps.

Sports injuries

Men may come to the pharmacy seeking relief and advice for minor sports injuries. These are likely to include blisters, bruises, cuts, minor head injuries, sprains, strains and tendonitis. These injuries can be caused by either not warming up properly before exercising, using inadequate equipment, pushing the body too hard or having an accident.

Self-care techniques that can be recommended are: resting the affected body part, taking anti-inflammatory painkillers such as ibuprofen to relieve pain and swelling, and using a bandage to provide support or plasters to protect blisters.

Cold packs can be sold to reduce swelling after a recent injury. Heat treatments such as wheat bags, heat pads, warming creams, sprays or hot water bottles should only be used on new injuries after 48 hours, or with chronic conditions such as overuse injuries and muscular aches and sprains to help relax and loosen tissues and to stimulate blood flow to the area.

Athlete's foot

Athlete's foot is a common fungal infection of the skin on the feet, particularly between the toes, causing it to become red, flaky and itchy. The feet may develop an unpleasant smell and if the infection spreads to toenails they may turn yellow, thicken, become brittle and crumble. Cracks in the skin may become infected.

Pharmacy staff can recommend OTC antifungal agents which come in a variety of creams, sprays and powders. With correctly applied treatment the condition should clear up within six weeks.

Athlete's foot is highly contagious, so advice should be given about changing shoes and socks to keep the feet cool and dry, and sufferers should be warned not to share towels. Severe infections should be referred to the GP, who may prescribe stronger antifungal medication.

Fungal nails

Fungal nail infections (onychomycosis) can affect part or all of the nail, including the nail plate, nail bed and root of the nail. The infection causes the toenails or fingernails to become thickened and discoloured and sometimes brittle, with pieces of nail breaking off. There are several OTC treatments that can be recommended in the form of liquids, solutions and creams that can help kill the fungus on the skin surrounding the nail.

In more extreme cases where the fungus has invaded the nail plate or bed, other OTC products (e.g. containing amorolfine) can be recommended or the customer advised to visit their GP and obtain a prescription for oral treatments such as terbinafine and itraconazole.