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18th November 2016

There’s something about Movember

Hollywood megastar Ben Stiller has helped to raise awareness about prostate cancer and prompted a debate about the need for a better test

In 2003, two friends – Travis Garone and Luke Slattery – were enjoying a beer in Melbourne, Australia, when they had an idea. What if they could find a way to raise awareness of, and funding for, men’s health. Specifically, they wanted to do for prostate cancer what other charities had done for breast cancer.

But they needed a hook: something novel, eye-catching and fun. At the time, the moustache had all but gone out of fashion. Even ironic hipsters wouldn’t risk it. Could Travis and Luke bring it back?

They found 30 guys to take up the challenge of growing a moustache for the full month of November – or Movember, as Travis and Luke would say. And when people asked why, oh why, they had forgotten to shave, they would take the opportunity to say it was all cancer awareness.

It was a lot of fun even though they raised no money!

Despite this, they knew there were on to something. The shock return of the moustache had been a great conversation starter and helped open the door to talking about men’s health issues at work, in the locker room and in the media.

The following year, they registered as a Foundation, attracted 480 participants and raised €30,000 for prostate cancer.

The campaign went viral, spreading to more than 20 countries with upwards of five million people taking part. Since its humble bar-room beginnings, the project has raised €543,000,000. Yes, you read that correctly! More than half a billion euro which has poured into research on prostate cancer as well as testicular cancer and other worthy causes.

Cause célèbre

Everyone from Justin Bieber to Johnny Depp have lent their upper lip to the cause, bringing priceless free advertising for Movember and cementing it in the fundraising calendar.

But not all celebrity awareness raising efforts are equally welcome. Actor, writer and director Ben Stiller has weighed in with a powerful personal story about his cancer diagnosis: “The prostate cancer test that saved my life”.

The test in question is the prostate-specific antigen (PSA) test which, as Stiller notes, is a simple blood test that detects a protein associated with prostate cancer. Once his doctor saw elevated levels of PSA, further tests were conducted followed by robot-assisted surgery to remove the cancerous cells from the prostate.

Ordinarily, disease awareness campaigners, patients and health professionals alike would rejoice at the sound of a Hollywood endorsement. The trouble in this case is that Stiller’s conclusion from his own experience is that more men like him should routinely have the PSA test.

As this goes against currently medical advice, it has sparked quite a debate. At present, doctors advise that men in their 50s – and those in their 40s with specific risk factors such as family history – should be screened.

But, as Stiller himself notes in his article, the PSA test is far from ideal. And while the logic of diagnosing early to improve outcomes usually holds true, it becomes shaky if the test is imperfect.

Doctors’ orders

Otis Brawley, chief medical officer of the American Cancer Society took Stiller to task. “The PSA tests sometimes miss cancer than needs to be found, and they find cancer that doesn’t need to be found,” he said. Men tested before the recommended age of 50 are more likely to receive a ‘false positive’ result, Brawley added.

This means many men are diagnosed with cancer and treated unnecessarily – enduring needless biopsies and surgery – while others suffer because their tumours are not picked up by the blood test.

For its part, Movember is sticking with the medical consensus and advises that men over 50 should be screened, unless they are at higher risk for genetic reasons. The Foundation notes that the test “still can’t answer lots of key questions about disease aggression, prognosis and progression”.

Better tests

However, Movember has donated tens of millions of euros to research projects, including the search for more sensitive prostate cancer biomarkers. The ideal test would not only pick up cancer every time, it would tell doctors how serious it is and what treatment – if any – is best.

These kinds of diagnostics can help reduce the need for tissue biopsies (which involve slicing a small piece of tissue from the patient). Other cancers, such as lung cancer, already benefit from ‘liquid biopsies’ – blood tests that identify cancer and help doctors decide whether certain medicines are likely to be effective.

In prostate cancer, the search for such a specific test continues. In the meantime, the PSA test is the best option available – even if it’s not right for everyone.

Still, here we are talking about prostate cancer again in November! Between them, Ben Stiller and Movember have (unwittingly!) combined to keep men’s health in the headlines this month.

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