Sometimes, it seems as if gay men have tunnel vision beyond HIV/AIDS. What about gay men, cancer awareness and risk? (As I write this, my own father is currently recovering from kidney cancer intervention surgery and the removal of one of his kidneys. I have personal reasons for my interest in this issue, quite apart from losing both of my maternal grandparents to cancer sticks and associated lung cancer. Added to which, Britain's Gay Times cunningly used cheesecake shots of naked musicians, film and theatre actors as a drawcard to the naughtier amongst us, admittedly. As for the naked readers, it was nice to see two fuller figured and fortysomething gay men game enough to disrobe. It's a sneaky way to interest us in the issue. Nice one, Gay Times!) In January, 2010, Gay Times alerted gay men to our own potential cancer risk outside the context of cancers associated with HIV/AIDS and opportunist infections. Because many of us don't visit doctors regularly and neglect focusing on other health issues, we may delay early detection and intervention, with a good chance of eradicating any traces of these medical conditions. If I have one problem with Peter Lloyd's otherwise excellent general article on gay men and cancer awareness, it is the false dichotomy between greater funding of breast and cervical cancer research detection, intervention and treatment and that accorded to prostate cancer. These gains were the result of feminist collective agency, mass mobilisation and effective lobbying. It also overlooks the fact that gay men do not exist in a vacuum. Many of us have lost grandparents, mothers, aunts, sisters and lesbian friends to the breast cancer epidemic. Unfortunately, some prostate cancer activists are also associated with the misogynist and homophobic male backlash movement, which may impede gay men from seeking information about prostate cancer risks and treatment options. As with depression and alcohol and drug problems, we need to widen our focus outside the context of HIV/AIDS and STIs. Later in the same issue, Martin Popplewell and Sean Cummings (FreedomHealth, London) argue for screening boys for human papillovirus and providing gardasil injections, which currently occurs with girls and young women. In women, HPV leads to the development of cervical cancer, even if women are now lesbian although have been sexually active with male partners beforehand. In the case of straight and gay men, HPV may lead to anal cancer, which has the same incidence as cervical cancer does amongst women. So, as Popplewell, Cummings and Peter Tatchell have all suggested, should we call for free gardasil injections be similarly extended to boys and young men, whether they ultimately turn out to be straight or gay? Good question. One hopes that New Zealand LGBT community groups adopt this as one of our own calls for improved services and prevention treatment. (One must also pay tribute to the late Farrah Fawcett's valiant struggle against her own anal cancer, and her willingness to share her brutal ordeal with the rest of us. Rest in peace, Farrah.) However, what are the most prevalent cancers around? I should note that the below are derived from UK statistics and there may be variations in prevalence in New Zealand's national context. Despite David Lloyd's comment that more men die from cancer, the most prevalent form is breast cancer, which predominantly affects women (although a tiny minority of men are also exposed). Despite persistent antismoking initiatives, lung cancer is the second most prevalent form. It doesn't exactly help matters that many lesbians and gay men smoke like chimneys. Bowel cancer is the third most prevalent form and is caused through excessive alcohol consumption, and that of red or processed meat. However, it can be offset by regular gym exercise and fruit and vegetables, given that obesity is one of the other risk factors. Therefore, we may be at reduced risk of that form of cancer, fortunately. Like breast cancer and female family incidence, male prostate cancer is the product of inherited genetic susceptibility. If your grandfather, dad, uncles or other male relatives have died from it, then you may be at risk. Age is also a risk factor, so older men need to visit the doctor especially. It is the most common male cancer. Lymphoma is the fifth most prevalent form of cancer and is associated with the lymphatic immune system and may or may not be an ancillary opportunist infection associated with HIV/AIDS. Clinicians need to be aware of this. Skin cancer is the sixth most prevalent form and is related to family genetics, fair skin, excessive sun exposure and sunbed use. Bladder cancer is the seventh most common form and like lung cancer, is often related to smoking, which affects the genitourinary tract in the same way as it affects the lungs...badly. Kidney cancer is the product of ageing, smoking and obesity- and like bladder cancer, it affects more men than women, as does oesophagal cancer, from the same causes- drinking, smoking and ageing, especially if one is over fifty. Finally, stomach cancer affects smokers, people on bad diets and those with excessive salt intake. So, which forms of cancer place gay men at particular risk? Fortunately, gym culture reduces our risk, as do associated sensible diets- while smoking increases risk in the context of lung, bowel, kidney, oesophagal and stomach cancer. In the specific case of prostate cancer, family history needs to be the chief determinant. Younger gay men need to talk to their dads about this, while older gay men need to check our family histories for any close male relatives in this context. What lessons can we draw from this? Let's be blunt. As a community, we need to stop being in denial about the respiratory, cardiovascular, genitourinary and digestive risks of heavy nicotine consumption and lobby the Ministry of Health for specifically targeted LGBT inclusive antismoking health promotion programmes, akin to those targeted at Maori and Pacific Island communities. I'm beginning to wonder if we don't need an LGBT branch of ASH, for that matter. Fortunately, our gym bunny tendencies also reduce risks from bowel, kidney, oesophagal and stomach cancers, although there's a trade off in this context that needs to be addressed in oncology research projects that specifically deal with this issue. Cancer is a gay male problem. What are we going to do about it? Recommended: Peter Lloyd: "Cancer Scare" Gay Times 375 (January 2010): 70-73. Martin Popplewell, Dr Sean Cummings: "Should Men be Given the Cervical Cancer Jab?" Gay Times 375 (January 2010): 92-93. David Bull: "Cancer" Gay Times 375 (January 2010): 122-123. Useful Books: Gerald Parlman and Jack Drescher: A Gay Man's Guide to Prostate Cancer: Binghamton: Haworth Medical Press: 2005. Annie Katz (ed) Breaking the Silence on Cancer and Sexuality: Pittsburgh: Oncology Nursing Society: 2007 [May also be of interest to lesbians and womens health activists] Margaret Wilmoth and Suzanne Provost (eds) Sexuality and Chronic Illness: Philadelphia: Saunders: 2007. Craig Young - 4th March 2010