What breast cancer is for women prostate cancer is for men. And yet the funding of prostate cancer research is less than half that for breast cancer. In 2012, the National Cancer Institute spent $602.7 million on breast cancer, but only $256.3 million on prostate cancer. This amounts to $2,590 per new case of invasive breast cancer as opposed to $1,100 for every prostate case.
Feminists who complain about gender discrepancies in every other corner of American life are oddly silent about the discrepancy in cancer funding. But they do no more than mimic the silence of American men.
The National Football League, for example, promotes “A Crucial Catch,” a month-long campaign “to support the fight against breast cancer.” During October, NFL players wear pink game apparel, which is later auctioned off to raise money for breast cancer research.
And prostate cancer? The league does nothing whatever, even though—if the rates in the general population hold for them—242 of the men on the NFL’s active rosters this season will eventually come down with the cancer and forty-seven of them will die of it.
What accounts for the discrepancy? It sure isn’t the patriarchy, which seems to have abandoned men on this issue.
Women are better organized—Susan G. Komen for the Cure, the country’s most successful breast cancer organization, raised $325.2 million in fiscal year 2013, while the Prostate Cancer Foundation raised 15.5% of that total—but to take notice of this disparity is merely to ask the question in different words. Why are men such lousy advocates for themselves?
I can’t speak for other prostate cancer patients, but if they are anything like me (and I suspect a good many are) the answer can be given in two words: sexual shame.
For more than seventy years, or ever since Charles B. Huggins discovered that tumors would shrink if deprived of testosterone, the treatment of metastatic prostate cancer has varied little. The treatment is castration.
Most men react as New York Times book critic Anatole Broyard did when apprised of the treatment:
My urologist, who is quite famous, wanted to cut off my testicles…. Speaking as a surgeon, he said that it was the surest, quickest, neatest solution. Too neat, I said, picturing myself with no balls. I knew that such a solution would depress me, and I was sure that depression is bad medicine.
Since the 1980s, luteinizing hormone-releasing hormone (LH-RH) agonists have gradually replaced surgery—that is, chemical castration now achieves a similar medical effect to cutting off a man’s balls. The psychological effect is only slightly better.
It has taken me six-and-a-half years to talk about being castrated. Only this past weekend did I confess to two of my closest friends that hormone treatments have left me impotent. And not merely impotent: I have been entirely drained of any sexual feeling whatever.
The effects of castration have a comical side. My pre-adolescent sons are not the only ones to groan “Yuck!” now when a man and woman start necking on screen. A sex scene in a contemporary novel transforms me into a thin-lipped censorious prude, flipping pages to escape the humidity. Feminine beauty is an abstraction: a Playboy Playmate arouses about as much physical response in me as the election results in Nauru.Comical or not, castration is an impoverishment of personality. What I have learned is that eros is hormone-based. A latter-day Dr. Johnson would undergo castration and announce: “Thus I refute Gilbert Ryle’s ‘Ghost in the Machine.’”
My sexual passion for my wife is a happy memory, like nostalgia for staying out till after dark playing pick-up baseball with friends. Our marriage really is between true minds; my body stays outside the door.
There is no cancer that does not impoverish the patient in some way. A mastectomy is just as damaging an assault upon a woman’s sexuality and self-image as castration upon a man’s, but women seem to be more fearless, less ashamed to contemplate the worst that might happen, more open to taking preparations for it.
But even with their head start in research spending and fundraising, women who endure breast cancer are largely invisible to the culture. From James L. Brooks’s Terms of Endearment (1983), in which Debra Winger bobbed her hair to signify the effects of chemotherapy, to Mike Nichols’s Wit (2001), for which Emma Thompson shaved her head, Hollywood only grudgingly acknowledged the physical stigmata of cancer. There is yet to be a major studio film, or even a good independent one, about a woman living with the emotional consequences of a mastectomy.
My wife Naomi, who is a physician, distinguishes between life-threatening disease and life-limiting disease. Advances in research, genetic mapping, and drug treatments have made even terminal cancer, for more and more patients, a chronic condition in which they may loiter, suspended between diagnosis and death, for several years.
To live with cancer’s physical limitations and yet not to permit them also to become mental limitations demands the summoning of an inner power—what Primo Levi calls “the power to refuse our consent.” In Auschwitz, Levi says:
We have learnt that our personality is fragile, that it is much more in danger than our life; and the old wise ones, instead of warning us “remember that you must die,” would have done much better to remind us of this great danger that threatens us.
To live with cancer is nothing like the struggle of all against all in a death camp, and yet perhaps cancer patients might learn something from Holocaust survivors. “To destroy a man is difficult,” as Levi writes, “almost as difficult as to create one”: and his destruction may precede his death. But only if he consents to it.
D. G. Myers is a critic and literary historian who taught for nearly a quarter of a century at Texas A&M and Ohio State universities. He is the author of The Elephants Teach and ex-fiction critic for Commentary. He has also written for the New York Times Book Review, the Weekly Standard, Philosophy and Literature, the Sewanee Review, First Things, Jewish Ideas Daily, the Daily Beast, the Barnes & Noble Review, the Journal of the History of Ideas, American Literary History, and other journals.
Image Used: Boxer of Quirinal (330 B.C.E.), Hellenistic Period, artist unknown, bronze