Let's hair it for health

PUBLISHED : Tuesday, 29 November, 2011, 12:00am
UPDATED : Tuesday, 29 November, 2011, 12:00am


For the past month, friends, colleagues and even strangers have scrutinised Nicolas Koehl's facial hair. Sometimes they're tactful and say he looks better without it. Other times they're more direct, and call his moustache stupid.

Koehl, 31, an IT engineer who moved to Hong Kong three years ago, doesn't mind. In fact, drawing attention to the moustache he's been painstakingly grooming since November 1 is exactly the idea. That's how he gets the chance to deliver his one-minute pitch on a subject close to his heart.

'You know, this moustache is for 'Movember', and the whole point is to raise awareness of men's health, particularly prostate cancer. I'm doing it not only to raise funds for cancer research, but also because my dad had prostate cancer.'

Since Movember began in Australia in 2003 with 30 men (known as Mo Bros) and women (Mo Sistas), the number of registered participants on movember.com has increased exponentially. Last year, 447,808 Mo Bros and Sistas worldwide raised a total of A$72 million (HK$552 million). Since 2003, there have been a cumulative 1.1 million participants, including such celebrities as James Franco and cyclist Lance Armstrong. A$178 million has been raised.

Awareness of prostate cancer has also gone up. According to the Movember Foundation, there was a 'frighteningly low level of awareness' of the disease in 2003. Some early participants were even unsure of where the prostate was in their bodies. (It's the walnut-sized gland that surrounds part of the tube which carries urine from the bladder to the penis.) It was shocking for a condition that is the most commonly diagnosed form of male cancer in many Western countries.

In Hong Kong, the incidence of the disease has increased at the fastest rate for all cancers affecting men. According to the Hospital Authority's Hong Kong Cancer Registry, the crude incidence rate in 2009 was 45 per 100,000, making it the third most common cancer among men. In 1989, that figure was 7.2. The death rate is also up, from 2.6 per 100,000 in 1989 to 9.3 in 2009, ranking it as the fifth biggest cancer killer among men.

Dr William Foo Wai-lum, director of Baptist Hospital's Radiotherapy and Oncology Centre and medical adviser to the Hong Kong Cancer Fund, says Hong Kong is simply catching up with the West, where prostate cancer has been the No1 cancer in men for the past 10 to 15 years.

'[The incidence in Hong Kong] is not even comparable to the West; we're just catching up,' says Foo. 'It's a lifestyle thing.'

Obesity, lack of exercise, and a diet that's high in meat and fat and low in veggies - 'part and parcel of the Western lifestyle', says Foo - are what doctors think are risk factors for not only prostate cancer but also for all modern cancers and conditions such as coronary heart disease, hypertension and diabetes.

Weight is a huge factor. A study by Duke University Medical Centre in North Carolina revealed in May that obese men face an elevated risk of their prostate cancer worsening, even when treated with hormone therapy to suppress tumour growth.

Genetics accounts for 'minimal' cases, says Foo. It's a disease of men aged over 60 and its risk increases proportionately with age. 'You can take a biopsy of the prostate of practically any man about age 80 on the street and I'm sure you'll find one-third have prostate cancer,' he says.

The median age of incidence was 73 years in 2009. With the city's ageing population, the number of cases can only be expected to rise.

Scientists have yet to identify the biochemical mechanisms underlying daily habits that lead to cancer, says Foo. Still, adopting a healthy lifestyle is advisable.

Koehl, a Swiss-Canadian, decided to overhaul the way he lived following his father's prostate cancer diagnosis in mid-2008. A stressful move to Hong Kong a few months later was also a factor. 'I realised that working in Hong Kong and living such a busy life would come with a price,' he says. So, he switched to a vegetarian diet and started playing sports regularly. He lost more than 22kg from his 1.9 metre, 93kg frame.

Getting regular health check-ups can also help. A prostate-specific antigen (PSA) test is a common way to determine the potential risk of developing prostate cancer. The test measures the amount of PSA, a protein produced by cells of the prostate gland in the blood.

An elevated PSA level can result from a number of factors, including benign prostate enlargement or inflammation of the urinary tract. Therefore, additional tests are needed. For example, if the doctor suspects cancer, a biopsy of prostate cells will likely be ordered to confirm the diagnosis. That's how Koehl's father was diagnosed. He had radiation treatment and is now in remission.

Kody Hennessey's father, however, was not as fortunate. 'He was a very healthy and positive person. But one day we found out his PSA was very high after a routine health review for insurance. He passed away one year later [in 2008 at age 59],' says Hennessey, 28, a business development manager with TMax Group who was inspired by his late father to keep a moustache for Movember.

The PSA test is controversial. 'The proponents think PSA will pick up early prostate cancer, but the opponents question whether picking up prostate cancer early can save lives. No conclusion has actually been reached,' says Foo.

Recent draft recommendations from the US Preventive Services Task Force suggest that the test may not save lives. The task force says the test often delivers flawed results. Two out of three men with raised PSAs do not have prostate cancer. This means they will endure unnecessary tests, such as the invasive biopsy. And about 15 to 25 per cent of men with prostate cancer may not have raised PSAs.

But a Mayo Clinic study released last month found a clear link between the PSA test and care. The study tracked more than 600 men aged between 40 and 79. Those in their 40s and 50s with a baseline PSA at or above the median PSA were more likely to undergo a biopsy and be diagnosed with low-risk prostate cancer. But nearly nine in 10 of the tumours found in both age groups were classified as 'low risk'.

According to the Health Department in Hong Kong, prostate cancer is not always an aggressive disease. Many with the condition do not have symptoms and do not die from it. These men do not really need treatment. The treatment may have side effects of its own, and can cause more problems than the cancer. 'Sometimes, [prostate cancer] won't even affect your life,' says Foo.

For those who do have symptoms, common ones of the condition include difficulty or delay in urinating, a slow or weak stream of urine, blood in urine, and pain in the lower back, pelvis and hips.

Regardless of the efficacy of the test, the goal of Movember is to change the way men think about their health. Health Department figures show that Hong Kong men are generally less healthy and access health services less frequently than women.

'I think this is universal in city men,' says Foo. 'When the economy is not that prosperous, men just want to make a living, support a family and improve their living standards.'

Perhaps the moustache will help change the face of men's health.


Incidence per 100,000 of prostate cancer in 2009 (in 1989, the incidence was only 7.2 per 100,000)

HK Cancer Registry

Checking up on these issues will help avoid checking out early

With each decade of men's lives come new health concerns. It's worth equipping them with the facts so they can be aware of what they need to talk to their doctors about at different stages of life. A few health checks apply to all decades: skin cancer, weight and blood pressure, cholesterol and mental health (depression and anxiety).


Testicular cancer - it's the most common cancer affecting young men

Harmful alcohol, tobacco and other drug use

Self-harm and suicide

Sexually transmitted diseases


Testicular cancer

Harmful alcohol, tobacco and other drug use

Blood glucose (diabetes)

Sexually transmitted diseases

Eye checks for glaucoma and other conditions


Prostate and colorectal cancers (particularly if there is a family history)

Blood glucose

Blood tests to check kidney/liver function and iron

Eye checks for glaucoma and other conditions


Prostate and colorectal cancers

Blood glucose

Blood tests to check kidney/liver function and iron

Tetanus booster (every 10 years)

Eye checks for glaucoma

60s and onwards

Prostate, colorectal and bowel cancers

Blood glucose

Blood tests to check kidney/liver function and iron

Pneumonia vaccine (from 65)

Bone density

Eye checks for glaucoma

Source: Movember Foundation