Why the British stiff upper lip makes a cancer diagnosis harder for men

The male tendency to downplay symptoms arises partly due to their reluctance to discuss health with their peers

“In the course of my military career I had been shot at, blown up and even experienced a couple of helicopter crashes, and always came away with barely a scratch on me,” says Captain John Culling, a veteran of the Royal Regiment Of Scotland. “But when I got diagnosed with kidney cancer, I felt as if my own body had started to attack me. I just couldn’t deal with it. I went from being a 60‐year‐old guy who was very fit and healthy, to being given a diagnosis of cancer. It really affected my head and at one point, I fully intended to take my own life. It got to the point where my suicidal thoughts became quite obsessive.”

Five years since his diagnosis, Captain John is still living with cancer but has managed to overcome many of the fears he initially faced. “Cancer is a word that makes people panic,” he says. “I had first noticed symptoms six months before I ever got tested, when I was waking up frequently in the night to pee. It was unusual but I just told myself to ignore it. My military career had taught me to just get on with it, not make a big deal of things and suck it up. I didn’t want to bother doctors by demanding tests. But I wish I had done. All I’d have needed was a simple blood test to have picked it up earlier.”

Captain John Culling, who was diagnosed with kidney cancer five years ago, has managed to overcome many of his initial fears

The King’s recent cancer diagnosis has probably made most of us reflect on our own vulnerabilities. While the King’s cancer – the type of which is not known to the public – happened to be picked up by chance during a prostate examination, many men with cancer are unlikely to receive the early diagnosis that is so crucial to cancer survival. Men are 60 per cent more likely to develop cancer in their lifetime than women and 70 per cent more likely to die from it. This is due in no small part to the later stage at which men tend to be diagnosed: a recent British study found that men were less likely to be diagnosed at stages one or two of almost every form of cancer than women.

It was eventually Captain John’s GP who sent him to be tested when his symptoms persisted. It is very often primary care services that first spot signs of cancer – but men remain far less likely to visit their GP than women. Studies show that three times as many males as females (6 per cent versus 2 per cent) had not had an appointment since being registered with their current GP practice. “Men tend to want to be stoic and deal with things on their own,” says Professor Mike Kirby, editor of Trends in Urology & Men’s Health. “But often GP surgeries feel more female-friendly. Seven in 10 GPs are women these days and some men are reluctant to get examined by female doctors, especially in common cancer sites such as the genitals or prostate.”

‘All I’d have needed was a simple blood test to have picked it up earlier,’ says Captain John

Paul Hales, 51 and originally from Manchester, was diagnosed with kidney cancer just before lockdown in 2020, while working as an anaesthetist in Melbourne. “Looking back, I ignored my symptoms, or at least tried to rationalise them,” he says. “I’d noticed a lump on my back months previously when it had got caught in a lift door. I’d decided it was benign and actually laughed about it with my family. I just thought it was another sign of getting old.”

But when the lump grew, he eventually requested a scan at the hospital where he worked. “It was a mate who performed the scan for me and I knew I was in trouble when he looked at the images and started crying. Because I had left it so long, the cancer had spread from my kidney to my lungs. I was riddled with tumors. I wish I had just got it looked at as soon as I noticed a problem.”

A combination of immunotherapy and surgery managed to defy the initial four to six weeks’ life expectancy doctors had given Paul. “It was all so sudden, from going in for tests to being told I could have a matter of weeks to live,” he says. “My first thought was ‘What am I going to tell the kids?’ They were in their teens and got very upset but, eventually, gave me unbelievable support to get me through the worst moments. The family as a whole tried to deal with it using a lot of humour and living in the moment. Four years later and I am still here, although not completely cancer-free just yet.”

The male tendency to downplay symptoms arises partly due to their reluctance to discuss health with their peers, says Prof Kirby. “Women tend to discuss health more openly with their friends,” he says. “This means that they can help to educate each other, ask advice and sometimes even alert their friends to possible problems. These sorts of discussions seem less common among male friendship groups and so there are less safeguards.”

Why it’s good to talk

Male reticence can also make life more challenging after a diagnosis. “In most support groups I visited I found it was the women who seemed more open about the emotional experience of cancer,” says Rob White from London, who was 49 when he was diagnosed with kidney cancer, after noticing blood in his urine.

“I felt there was widespread expectation that men should be brave in a particular, emotionally restrained way. But, who knows, emotional honesty can be part of facing cancer bravely, although that approach goes a little against social norms for men. For myself, I think such honesty is healthy, and I would encourage men to open up when facing such a big challenge as cancer.”

Rob White was diagnosed with kidney cancer aged 49, after noticing blood in his urine

Dr Troy Chase is a clinical psychologist at Maggie’s, a network of cancer support centres built beside NHS hospitals across the UK. “There is no right or wrong way to deal with cancer,” he says. “But generally speaking I have observed that those who are willing to communicate with others about their illness have coped better. If you talk about the issues you are facing, you are more likely to get the support you need whether that be advice about symptoms, help with financial or professional worries or just the emotional release of telling someone how you are feeling and receiving some empathy.”

Rob White found his own local Maggie’s centre at St Bartholomew’s Hospital in London to be a huge support. “As a man diagnosed with cancer, it meant the world to me that I found a place where I could discuss feelings of fear and sadness with specialists who have extensive knowledge about all aspects of cancer as well as the skill to listen and advise effectively,” he says.

It often seems as if men are being constantly told to “open up” about their feelings – even when many of us feel extremely uncomfortable doing so. Does the onus have to always be on the patient to change their behaviour patterns in order to get better? “No,” says Dr Chase. “Many of the male patients I work with say they just appreciate being given the space to continue with normal relationships, without the need to constantly talk about the illness.”

Paul Hales certainly found the support of his old friends in Manchester a huge help – precisely because they so rarely mentioned his cancer. “I received about 250 messages of support in the weeks after my diagnosis,” he says. “But after a year the regular messages were just from a small group of very old mates who cheered me up by taking the piss and talking about football. Sometimes, the ability to just talk the usual rubbish with your mates and have a laugh is the most powerful thing of all.”

Which is a reminder to any of us with male friends who might be going through something similar to the King right now: just be there. “You might find it awkward and not know what to say to a friend with cancer,” says Dr Chase. “But it really doesn’t matter what you say as long as you make sure you are available. Whatever you do, don’t ever ‘ghost’ a friend with cancer.”

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