No-Shave November? Let’s do more than stop shaving

As we move into November and inch closer to the much-anticipated closure of the year 2020,

many of us may start noticing some of our otherwise clean-shaven male counterparts getting a little bit… hairier? Sure, the pandemic era has seen a growing number of quarantine beards and increasingly popular mustaches, but the month of November brags the title “No-Shave November” for many – men and women alike.

No-Shave November began in 2009 when a Chicago-based family created the campaign to raise awareness and money for cancer, two years after the death of their father from colon cancer. The concept caught on, and in 2013, the campaign partnered with the American Cancer Society and has since raised millions of dollars in funds for cancer research. Founded a few years before No-Shave November, in 2003, the Movember foundation was started by two men in Australia with the intention of raising awareness and money for prostate cancer by growing mustaches. They have since partnered with the Prostate Cancer Foundation of Australia and Beyond Blue, Australia’s national initiative for mental health and wellbeing. Lastly, November is also the formal awareness month for pancreatic, lung, stomach, and carcinoid cancers.

So, with all the hype November carries for cancer awareness, let’s talk about it. Awareness is a vital first step in achieving the grand goal of ending cancer, particularly cancer-related morbidity and mortality. Fun communal campaigns, such as No-Shave November, Movember, and various recognitions of “[X] cancer awareness month” like ornate social media photo filters, colored ribbons, and awareness-focused events, are great ways to increase recognition and even raise money through a sense of camaraderie. Awareness can also help promote earlier diagnosis by encouraging patients to pursue regular screening and catch symptoms earlier. However, despite advances in cancer treatment, inequities in cancer screening, management, care, and survival outcomes persist.

Addressing these inequities is vital to successfully ending cancer. No matter how advanced

cancer treatment becomes, the goal of ending cancer will not be reached unless we make those treatment advances available and accessible to all, regardless of race, ethnicity, socioeconomic status, insurance status, and zip code. Some racial inequities outlined by the National Cancer Institute include:

• Higher cancer-related death rates in Black Americans

• Black women are more likely to die of breast cancer, and the mortality gap is widening

• Black individuals are more than twice as likely to die of prostate cancer as to white individuals

• Black individuals are almost twice as likely to die of stomach cancer as white individuals

• Black individuals have a higher incidence of colorectal cancer than white individuals, and this inequity has not changed despite a declining incidence in both Black and white individuals over time

• Black women have the highest rates of death from cervical cancer than all other racial/ethnic groups

• Black men have a higher incidence of lung cancer and lung cancer-related deaths, though the inequity in incidence seems to have resolved for young Black men

• Black individuals are more than twice likely as white individuals to be diagnosed with multiple myeloma and die from it

• Higher rates of cervical cancer, liver cancer, and intrahepatic bile duct cancer in Hispanic and indigenous Americans/Alaskan Natives

• Higher rates of kidney cancer in indigenous Americans/Alaskan Natives

• Spanish-speaking Hispanics are less likely to be screened for colon cancer than whites or English-speaking Hispanics

Inequities in cancer care appear clearly based on one’s zip code. According to a 2018 article by Lauren McCullough and Dr. Christopher Flowers published in the Journal of the American Medical Association, approximately 15% of the US population lives in a rural area. Worse survival rates have consistently been demonstrated in rural patients, particularly for lung, colorectal, prostate, and cervical cancers, all of which are cancers that can be diagnosed early through regular screening. Though these adverse outcomes are complex and multifaceted, the results of McCullough’s and Flowers’s study

demonstrated that receipt of guideline-driven cancer care seemed to eliminate these outcome disparities. It can thus be assumed that targeting barriers to comprehensive care access such as poverty, insurance barriers, limited screening, lack of transportation, and limited access to specialized care can effectively rid many of these inequities in cancer morbidity and mortality experienced by rural patients.

All in all, though awareness is certainly a valuable step in ending cancer, and financial donations to cancer research can further advance care, the end goal is never going to be met if we do not also prioritize addressing the inequities experienced by so many in their cancer journeys, particularly as it relates to access to screening and comprehensive, guideline-driven cancer care.