“We Remain Very Much the Second Sex”

Abstract

Informed by social constructionism, biomedicalization, and a feminist framework, a discourse analysis was performed on 31 popular news articles published in North America between 2000 and 2010. The magazines construct prostate cancer in a gendered manner. Its construction is rooted in themes that are related to discussions of biology, prostate cancer as a heterosexual problem, the responsibilization of health and masculinity. Through these constructions, the popular news articles reinforce dominant ideals and performances of hegemonic masculinity and male sexuality, traditional femininity, and heteronormativity. While reinforcing such ideals, the prevention, treatment, and knowledge of prostate cancer is constructed as the responsibility of individual men. This study reveals that the articles favor discussions of heteronormativity and hegemonic masculinity over racism, rendering health inequalities silent.

The purpose of this research is to examine the portrayal of prostate cancer in high-circulating popular news magazines—Maclean’s, Newsweek, Saturday Evening Post, and Time Magazine—published in English in Canada and the United States between January 2000 and December 2010. Media are important to the everyday lives of most individuals as media provides and offers entertainment, advertising, news, and information. This includes television, films, radio, newspapers, magazines, and the Internet, which are all significant components in our mass culture. Mass media reflect, reinforce, and reproduce ideologies as well as culture and is created within dominant society. Thus, media is influential as it helps construct reality (Clarke, 1999; Lorimer & McNulty, 1991).

Mass media is a tool used to communicate the definitions of “good” health and ideas about health promotion and prevention. This includes encouraging behavior to achieve “good” health through the promotion of general information about health issues, risk, and the promotion of health commodities and testing. It also includes encouraging the abandonment of practices that are understood to hinder and prevent “good” health (Lupton, 1995). In this way, mass media is often understood to be educational (Lupton, 1995).

Mass media is a primary source of knowledge and health literacy for many individuals. This includes mass magazines where health is a popular topic—referred to by Cranshaw (2007) as “magazine medicine.” Mass magazines, as a form of print media and a tangible medium, can be passed from person to person, making the possibility of circulation and influence as well as health literacy greater. Individuals often turn to media sources, including magazines, for information about health, including treatments, discoveries, and prevalence (Clarke, 1999). Media can both influence people’s behaviors and understandings about health; how they talk about and interpret their health, symptoms, and risk; and the social and political policies related to health (Clarke, 1999). Thus, media plays a significant ideological function in North American society as dominant views, understandings, and ways of doing health are presented in various forms.

Prostate cancer is one of the most common male cancers affecting hundreds of thousands of men in North America mostly over the age of 50. In 2007, 22,300 Canadian men were diagnosed with prostate cancer and an additional 4,300 men died the same year. Today, in Canada, 1 in 7 men is expected to be diagnosed with prostate cancer, and 1 in 28 is expected to die from it. The risk of developing prostate cancer increases with age as men have a lower probability of being diagnosed before the age of 50 but have a higher risk once they reach the age of 70. Diagnosis usually occurs between 60 and 69 and death after the age of 80. Today men diagnosed with prostate cancer are living longer as the death rate is significantly lower than the incidence rate (Canadian Cancer Society, 2011).

Prostate cancer only occurs in the anatomically male body. Prostate cancer is also a disease that occurs in the male sexual anatomy that is associated with masculinity, manhood, and male sexuality (Clarke, 1999). Thus, particular attention was paid to themes and discourses that are related to gender as there is an undeniable connection and relation between masculinities and health (Sabo & Gordon, 1995).

Literature Review

Health and Masculinity

Dominant forms of masculinity affect the health habits of men, their actions, and how they understand particular conditions. Masculinity prescribes that men are more likely than women to adopt certain behaviors that increase their health risks. Masculinity also prescribes that men are less likely to engage in behaviors that are linked to longevity and good health. Health-related beliefs and behaviors are ways in which men demonstrate masculinities, and such unhealthy beliefs and behaviors sustain and reproduce social inequality. It also sustains the social structures that reward men’s poor health habits (Courtenay, 2000). Help seeking is related to this as men often endorse and reinforce the hegemonic male practice of not seeking help and taking excess risks. Help seeking is often only undertaken when help seeking is perceived and understood as a way to restore as well as to preserve aspects of masculinity (O’Brien, Hunt, & Hart, 2005).

Men and Experiences With Prostate Cancer

Despite debate surrounding the efficacy of prostate-specific antigen (PSA) screenings, nearly half of Canadian men over the age of 50 report having several PSA screenings over their lifetime. PSA screenings mostly occur because of anxiety and because of how PSA screening is constructed as imperative in the media (Beaulac, Fry, & Onysko, 2006). Men who do not participate in the screenings do not do so because they do not have symptoms; they are embarrassed because of the procedure, the fear surrounding cancer and diagnosis, and general confusion about the screening (Ferrante, Shaw, & Scott, 2011).

Ideals and performances of masculinity affect how men do and understand their health and their prostate health. Some men understand induced impotence because of treatment as a “small price to pay” whereas others relate their impotence to their masculinity and manhood (Chapple & Ziebland, 2002). Men frequently maintain and rarely resist dominant definitions of masculine sexual identity as prostate cancer is understood to threaten their sexual abilities and sexual experiences (Arrington, 2008). Some men redefine their masculinity, seeing impotence and incontinence as a trade-off for their life (Oliffe, 2005). Others prescribe to hegemonic masculine ideals, concerned with preserving their sexual function as well as their manhood (Bokhour, Clark, Inui, Silliman, & Talcott, 2001; Fergus, Gray, & Fitch, 2002).

Health, Masculinities, and the Media

Media construct men’s health in relation to hegemonic masculinity. Newspapers, for example, reproduce stereotypes about masculinity and health (Gannon, Glover, & Abel, 2004; Gough, 2006, 2007) and reinforce hegemonic masculinity in articles. Print magazines also portray similar ideals as men are almost always depicted in traditional male roles in images and advertisements (Vigorito & Curry, 1998). Male power, domination, and hegemonic masculinity are also reproduced in magazines made for men. This includes Men’s Health, where men are portrayed as bodybuilders, meat eaters, beer drinkers, heterosexual champions, and television watchers (Stibbe, 2004). Diseases and illnesses are also presented as a direct threat to masculinity (Cranshaw, 2007; Gannon et al., 2004). Discussing male-specific health conditions including prostate cancer and sperm count, magazines also construct an individual subject who is interested in managing their health and engaging in an ongoing body project (Cranshaw, 2007).

Media, Cancer, and Prostate Cancer

Medicalization dominates media stories about cancer. There is a specific focus on fear, confusion about diagnosis, and discussions of treatments (Clarke & Everest, 2006). Prostate cancer is constructed as a direct threat to masculinity and manhood (Clarke, 2004). Newspaper articles discuss funding for men’s health and also construct treatment as imperative for all men (Haplin, Phillips, & Oliffe, 2009). As such, the newspapers prescribe and replicate hegemonic masculinity (Haplin et al., 2009; MacKenzie, Chapman, Holding, & McGeechan, 2007). Magazines also discuss funding for prostate cancer, call for the formation of an all male brotherhood, and make direct reference to masculinity (Clarke, 1999). Thus, as magazines focus on the threat to masculinity, prostate cancer is portrayed as gendered (Clarke, 1999; Hoon, 2005).

Despite all this research, there are no recent studies on popular news magazines and the constructions of prostate cancer. With this gap in scholarship, this research has updated Clarke’s (1999) and Hoon’s (2005) work on prostate cancer with a focus on popular news magazines.

Method

Social constructionism, biomedicalization, and a feminist framework informed this study. Social constructionism allows for the examination of how “truth” and “reality” are constructed (Atkinson & Gregory, 2008). Health and illness are socially constructed and experienced. Media plays an important role in this construction. Biomedicalization also informs this study. It is characterized by its focus on biology as well as the shift from control over the external nature of illness to the transformation of the individual nature of illness (Clarke, Mamo, Fishman, Shim, & Fosket, 2003). This research adopts biomedicalization’s focus on surveillance and responsibilization (Clarke et al., 2003).

The research also adopts a feminist framework. Such a framework and approach is appropriate as it has a specific focus on issues that are related to gender. As a gender aware and sensitive approach, a feminist framework lends itself well to the analysis of prostate cancer as a gender-specific disease (Clarke, 1992, 1999) understood through discourses of masculinity (Sabo & Gordon, 1995). This is a discursive analysis, and as such, the texts are not analyzed in isolation. Rather, the articles are linked to the larger social structure, historical ideals and dominant ideologies, and values and views. Texts are important to study as they reflect, reproduce, and reinforce social norms, dominant ideologies, and culture (Lupton, 1994a).

Sample

The sample for this research was based on everything published in popular news magazines between January 2000 and December 2010 in English, circulated in Canada and the United States. In total, 31 articles were published in four popular news magazines—Maclean’s, Newsweek, Saturday Evening Post, and Time Magazine. Popular news magazines were categorized as “popular news magazines” based on the magazines’ focus and popularity. These magazines provide their readers with articles that are more focused on the daily happenings and current affairs in North America and around the world. Popular news magazines were chosen as the sample based on the significant number of articles that were published in these types of magazines. Between the years under study, 107 articles were published on prostate cancer (see the appendix) with 30 published in four popular news magazines.

This time period—2000 to 2010—in fact is an important period to study. It captures the aftermath of the second highest peak in prostate cancer incidence that occurred in 2001, when the incidence rate of prostate cancer rose to 130 per 100,000 compared to 110 in the mid-1990s (American Cancer Society, 2011; Canadian Cancer Society, 2011). As the second highest peak in the last 30 years, the first occurring in the early 1990s with the introduction of PSA screening, there was a push for more awareness about prostate cancer—a push by the medical community, survivors and awareness groups, and the media. This awareness led to more screening for men as there was and continues to be a focus on early detection (Canadian Cancer Society, 2011). Since 2001, prostate cancer–related deaths has decreased as men today are more likely to live when they are diagnosed with prostate cancer than ever before (American Cancer Society, 2011; Canadian Cancer Society, 2011; Centers for Disease Control and Prevention, 2012; see also Andriole et al., 2009, for more on PSA screening).

Data Collection and Analysis

Articles were gathered using The Readers’ Guide to Periodical Literature database. Several searches were conducted using the following terms: prostate cancer, PC, prostate specific antigen, PSA. Once the articles were obtained, the process of analysis began. Modeled after Clarke’s procedural method (Clark, 1999, 2004; Clark, McLellan, & Hoffman-Goetz, 2006), the analysis included a number of stages performed by the first author and then discussed with the coauthor. First, all of the articles were read over to become familiar with the breadth of articles gathered. Discourse analysis was performed as the second step. Here, there was a focus on metaphors and language that is used to reproduce social norms. We asked the following questions: What stereotypes are maintained in the texts? What norms and values are privileged in the articles? What ideas, values, and beliefs are present (Lupton, 1994a)? Following this, the third step was completed, which consisted of a third read-through, where special attention was given to what is silenced and absent.

Findings

The following are the results of the analysis and the ways in which prostate cancer is constructed in popular news magazines.

Biology

The Biological Man’s Disease

Prostate cancer is constructed as a “man’s” disease whereby a “man” is defined biologically in relation to genitalia as well as the prostate. It is true that to have prostate cancer, one must have a prostate, but having a prostate does not mean that individuals identify as men. Gender and sex are not the same as sex does not determine gender, and masculinity and femininity are not necessarily connected to anatomically male and female bodies (Lorber, 2008). Illustrations of this follow: “The male equivalent [to breast cancer] is prostate cancer—the most common and second most lethal form of the disease among men” (Maclean’s, 2001). ¹ The biological man is also in Newsweek—“It is what God gave men instead of breasts: a complex piece of reproductive equipment whose usefulness declines over time” (Newsweek, 2003A).

In the articles, prostate cancer is constructed and understood as a “man’s” disease where “men” are defined biologically and anatomically as men have prostates. Intersexed, transgendered, or anatomically male individuals who identify as other identities are not understood as “men” in these discussions of prostate cancer. Gender and sex are understood as equivalent where biology is undeniably linked to gender.

The Brotherhood

Articles discuss men as belonging to a brotherhood where men are understood as having the same health concerns because of their male bodies. They are individuals who may be diagnosed, should be tested, are also those that have prostate cancer, and those that have been treated for the disease. Throughout the articles, words such as “we” and “us” are common.

In a Newsweek article, it was explained that

Men may excel at building empires, but we’re not much for taking care of ourselves. . . . But for all the healthy progress we’ve made in recent decades—more gym memberships, more medical tests, less smoking, safer workplaces—we remain very much the second sex. (Newsweek, 2003B)

The brotherhood is also found in Maclean’s as it was explained that as men “we” need to take care of our health:

Middle-aged boomers like me who act like we’re bulletproof when, in fact, we’re prone to a host of serious ailments. We shy away from medical care…. So do the stats. One in seven Canadian men will get prostate cancer; one in 26 of us will die from it. (Maclean’s, 2005)

Here, the articles have created a homogenous group of men who because of their bodies and their prostate are a part of a male-only brotherhood. This is problematic, as in doing so, the articles uphold and reinforce the connection between biology and gender.

Prostate Cancer as Comparable to Breast Cancer

Prostate cancer is constructed as a male disease comparable to breast cancer, a female disease. Through these comparisons, both diseases are understood to be the equivalent disease for each gender. Here, the equivalency is related to what is affected by the disease—prostate cancer affects the prostate, a gland that is related to the penis, a male-only sexual organ, whereas breast cancer affects breasts, which, although not female-only, are associated with the sexualized female body. With this comparison, both cancers are understood to be gender specific and are cancers that affect the defining aspects of what it means to be male and female.

An article in Maclean’s, which discussed testing and prevention for several different cancers, proclaimed after discussing breast cancer: “The male equivalent is prostate cancer—the most common and second most lethal form of [cancer] among men” (Maclean’s, 2001). In Newsweek, it was explained that as men, as the “second sex,” “[a penis] is what God gave men instead of breasts: a complex piece of reproductive equipment” (Newsweek, 2003A).

In previous research (Clarke, 1999), the comparisons between prostate cancer and breast cancer were linked to funding, but here, funding is not discussed. Rather, the two diseases are simply presented as diseases that are gender specific. By comparing breast cancer and prostate cancer, the articles reduce male and female bodies to biology. Through the comparisons, gender and sex are constructed as the same where biology is understood as a determinant of gender and as a determinant of what disease can affect what bodies. The emphasis on biology allows for the clear differentiation between men and women, thus reinforcing the gender binary where men and women are classified as two distinct and opposite bodies.

Heterosexual Problem

Prostate cancer is constructed as a heterosexual problem as articles emphasize the role of a female partner. Although any partner can play an important role in any health experience, in only discussing heterosexual couples, the articles construct prostate cancer as a heterosexual problem, maintaining heteronormativity.

In Maclean’s it was explained that “At 6 a.m. on Feb. 13, 2001, then federal health minister Allan Rock and his wife, lawyer Debbie Hanscom, walked hand in hand down University Avenue to the Toronto General hospital” (Maclean’s, 2002). In The Saturday Evening Post as well, on researching about surgeons, Ralph explained that a surgeon “was, in fact, rated eighth nationally. When it comes to surgery, volume means a lot. My wife and I traveled to Austin” (The Saturday Evening Post, July/August 2006).

Prostate cancer is also related to the enactment of heterosexuality. In Time Magazine, heterosexual sex is discussed in an article that looked at the possible links between testosterone and prostate cancer. It was stated that “there are social implications connected to the one area in which we know for a fact that testosterone matters—sex drive. Married men tend to have lower testosterone. It’s evolution’s way of encouraging the wandering mate to stay home” (Time Magazine, April 2000). In this example, having a sex drive is linked to heterosexual marriage and heterosexuality. In only portraying heterosexual couples in relation to prostate cancer, the articles construct prostate cancer as a disease that only affects heterosexual men. In doing this, the articles reinforce heteronormativity.

Responsibilization of Prostate Health

Prostate cancer is constructed as an individual’s responsibility—with the shift to biomedicalization, health has become a moral obligation whereby health is an individual goal as well as a moral responsibility (Clarke et al., 2003).

Be Educated, Get Tested, and Change Your Lifestyle

Men are responsibilized throughout the articles. This means that they, as individuals, are to take the responsibility of becoming informed and being knowledgeable about prostate cancer, getting tested, and changing one’s lifestyle to prevent prostate cancer and have “good” health.

Readers are informed that they must be educated about prostate cancer. In Time Magazine, it was stressed that “you will have to gather and weigh all the information you can when deciding how, or even whether, to treat prostate cancer” (Time Magazine, September 2002). The Saturday Evening Post published an article as a guide to prostate cancer screenings, guiding readers in what actions to take based on their PSA scores (The Saturday Evening Post, September/October 2006B).

Men are also portrayed as obligated to get tested. An article in Maclean’s argued that when it comes to testing, “Low-income men in the U.S. can make an economic excuse—many have no health insurance. There’s no excuse in Canada.” The article finished by explaining that survivors say that what is most important in their “battle” against cancer was “going to our doctors and treating our cancers early” (Maclean’s, 2005). In Time Magazine, an article detailed that the “importance of annual checkups that include both a PSA blood test and the infamous gloved-finger rectal exam” cannot be stressed enough. The author concluded, “When it comes to prostate cancer, early screening can mean the difference between life and death” (Time Magazine, 8 May 2000A).

Men are also responsiblized for their diet. Maclean’s offered readers “Personal Choices” list that detailed the many ways by which men can alter their lifestyle for better health. The article recommended a change in diet—“five to 10 helpings of fruit and vegetables daily” (Maclean’s, 2001). In Newsweek, readers are provided with details about “Diet and Lifestyle Change” that will improve the detection of prostate cancer and improve their health overall (Newsweek, 2003A).

Responsibilization also occurs through discussions of exercise. One Newsweek article detailed the experience of John Stone. As part of his health plan, for Stone

who rarely exercised and once reached 300 pounds, the [exercise and lifestyle] program has done more than lower his PSA. . . . It’s changed his life. He’s dropped about 50 pounds, to 195, and lowered his cholesterol from about 200 to 135.

The article concluded by stating that “only 3 in 10 adult Americans exercise either vigorously (jogging for 20 minutes three days a week) or moderately (walking for at least 30 minutes five days a week)” (Newsweek, 2002).

Individual men are responsibilized for their health, which occurs with education, testing, diet, and exercise. The responsibilization that occurs within the articles is problematic as it ignores the connection between health, social structure, social conditions, and inequalities. The articles completely overlook political, economic, and social realities of men—poverty, racism, access barriers, social exclusion, and experiences of inadequate health care (Dilorio et al., 2011; James, 2009; McGibbon, Etowa, & McPherson, 2008).

“Easy” to Prevent, Treat, and Recover From

The articles construct prostate cancer as a disease that is easy and simple to prevent, treat, and recover from. Because it is “easy,” men do not have any excuses. This is because it is a disease that does not require much effort or work for any individual man. A Maclean’s article stated that prostate cancer is “the most common and second most lethal form of . . . [cancer] among men. It continues to take a terrible toll of lives, despite the existence of a simple screening test” (Maclean’s, 2001). One author also explained to readers that “A PSA blood test is easy to perform and easy to interpret. It costs the patient from $20 to $25” (Maclean’s, April 2002). Along with prevention and the PSA test, Newsweek explained the ease of treatment: “Bob Klaus . . . had laparoscopic surgery on a Wednesday, went home on Friday, and returned to work on Monday” (Newsweek, 2003A).

Because the processes and procedures related to prostate cancer and prostate health are constructed as “easy,” not participating in such procedures is understood to be irresponsible and neglectful. There is an assumption in the articles that what is “easy” and “simple” is “easy” and “simple” for all men. In constructing prostate health as such, the articles ignore the social realities of men and the ways in which these realities affect health.

Women as Caregivers

Women play a significant role in prostate health in the magazines studied. Positioned in the caregiving role, women are constructed as individuals who are to direct and assist in the managing of men’s “good” health.

In an article that detailed the diagnosis of the former mayor of New York Rudy Giuliani, Newsweek explained that with his diagnosis, Giuliani “craved the company of his new significant other” as he stated that “I’m going to need her more now than maybe I did before.” His new significant other, Judi Nathan, was his “wellness program. Warm and upbeat—a nurse by training–[Judi] Nathan is said to be willing to listen devotedly to his fears and concerns” (Newsweek, 22 May 2000). Discussing women’s roles as well, Joe Theismann, an American football athlete, stated that “I also appeal to men’s spouses. If you care about the significant man in your life, encourage him to get a physical” (The Saturday Evening Post, 2005).

Women are responsibilized for other’s “good” health. The construction of women as caregivers in relation to prostate cancer is indicative of women’s larger societal roles as mothers, wives, and traditional roles for women in the workforce. Through this construction, the articles uphold and reinforce traditional gender roles and traditional femininity (Mroz, Chapman, Oliffe, & Bottorff, 2011) while at the same time reinforcing hegemonic masculinity. Here we want to make clear that it is not to say that women should not be caregivers or that women or partners should not or cannot have a role in the health of their partners. Rather, what is problematic here is that by positioning women as sole caregivers, men are oppositely positioned as being incompetent with their health, relying on women for their health improvement.

Masculinity

Threat to Sexual Function

Prostate cancer is constructed as a threat to sexual function within the articles studied. These discussions focus on the threat prostate cancer and treatments have on sexual function. Male sexual function is constructed and portrayed as a defining aspect of the male identity (Oliffe, 2005).

One Maclean’s article stated, “For many men, sex is a signature act, primal and necessary to their identity” (Maclean’s, April 2002). Another Maclean’s article detailed that with new technology, men will not experience “debilitating side effects” including “erectile dysfunction, which for many men can make the choice between existing treatments as cruel as the disease itself” (Maclean’s, 2004). A Newsweek article explained, “When John Stone found out he had prostate cancer, he researched the conventional interventions, including surgery and radiation, and quickly learned the truth–they … can cause impotence and incontinence” (Newsweek, 2002). In Time Magazine, one author wrote, “What’s needed is a better way to figure out who will benefit from treatment and who can safely avoid it and its unfortunate side effects, which can include impotence and incontinence” (Time Magazine, March 2002).

In highlighting male sexual function, the articles uphold and reinforce hegemonic masculinity. Sexual function is an aspect of the normative male behavior as men are to be able to participate in heterosexual intercourse. The penis is understood as a part of their manhood. It is also an aspect of masculinity and the male body that distinguishes all men from females and femininity (Oliffe, 2005). Prostate cancer thus is constructed as disrupting male gender identity and is a threat to masculinity.

The Prostate Battle

War metaphors are used in the articles to discuss prostate cancer, treatment, and survivorship. This type of language constructs the “fight” against prostate cancer as one that requires men—the warrior—to have strength and force against the enemy—prostate cancer. In Newsweek, it was detailed that Giuliani’s “trademark toughness will be his best weapon in the battle ahead” (Newsweek, 8 May 2000). Another article explained that Giuliani was thinking “about how to defeat the kind of cancer that killed his father” (Newsweek, 22 May 2000).

The language of warfare is common in public health discourse as the body is understood to be “under attack” while medications and procedures are depicted as the “defense” (Lupton, 1994b). As the “defense,” the war and battle metaphors emphasize the importance and immediate need for medical intervention (Clarke & Everest, 2006). The language and metaphors are in fact related to the characteristics of the ideal man. He is to be physically strong, having the strength to fight in order to win battles. Here metaphors and war language relate survivorship to hegemonic masculinity where hegemonic masculine traits are constructed as imperative and needed to “beat” prostate cancer.

The “Good Fight”

Many articles emphasized men’s courage and stoicism during treatment and recovery. In The Saturday Evening Post, one article explained that for one man, “The procedure lasted one and a half hours . . . Postop required one pill. [He] was up and walking the day of the surgery and out the next day” (The Saturday Evening Post, July/August 2006). A Newsweek article informed readers of one man’s endurance with prostate cancer. Choosing to change his lifestyle and diet dramatically, John Stone’s PSA lowered, he became fit, and “he lost his fear” surrounding prostate cancer (Newsweek, 2002). A Maclean’s article focused on former federal Industry Minister Allan Rock’s battle with cancer: “During the six-week wait for surgery, Rock increased his training and began running 8 to 10 km each morning in sub-zero Ottawa weather . . . [his operation was] on Feb. 13 and Rock was discharged just three days later” (Maclean’s, April 2002).

There is also one article in Maclean’s that constructs the “fallen hero.” Titled “Farewell to a Titan,” the author detailed the passing of Pierre Trudeau who had “succumbed to prostate cancer.” Focusing on his achievements and successes, readers are informed that “the country responded with an outpouring of emotion, more muted perhaps than the tidal wave of Trudeaumania . . . but no less warm. And dignified, as befitted the man who had swashbuckled” through Canadian politics “and yet somehow, always risen above it.” The author continued, “And across Canada, ordinary Canadians . . . were inspired again” (Maclean’s, 2000). Through this article, Trudeau is portrayed as a “fallen hero” who fought nobly in all of his battles.

Those treated for prostate cancer are portrayed as courageous, brave, strong, and stoic throughout the articles. In these articles, hegemonic masculinity is portrayed as important and needed to survive prostate cancer. Hegemonic masculine traits are constructed as imperative when an individual is diagnosed with prostate cancer (Haplin et al., 2009). Such constructions are problematic as they do not include ideals and performances outside of hegemonic masculinity. They also do not reference fear, the effects of cancer on loved ones, experiences with doctors, and difficulties often experienced in recovery.

Discussion and Conclusion

This research has documented how prostate cancer has been constructed in popular news magazines. This included articles published in Maclean’s, Newsweek, The Saturday Evening Post, and Time Magazine published between January 2000 and December 2010. This study extends previous results of earlier work that focused on prostate cancer and media (Clarke, 1999, 2004; Haplin et al., 2009; Hoon, 2005; MacKenzie et al., 2007) as well as on men’s health and media (Clarke & Robinson, 1999; Cranshaw, 2007; Gannon et al., 2004; Gough, 2006, 2007; Stibbe, 2004; Vigorito & Curry, 1998). It has been concluded that the articles published in the popular news magazines construct prostate cancer as gendered—the articles reinforce dominant ideals and performances of hegemonic masculinity and male sexuality, femininity, and heteronormativity. Furthermore, the prevention, testing, treatment, and knowledge of prostate cancer are constructed as the responsibility of individual men.

Discussions of prostate cancer are essentially discussions of gender. When discussing prostate cancer, including experiences and general information about the disease, the articles point to gender performances where men are to be masculine and embody strength and bravery, whereas women, who have a role in prostate health, are to embody femininity as caregivers of men. Talk of prostate cancer, thus, is talk about “doing gender” (Lorber, 2008, p. 534).

The reinforcement of gender and gender roles is constraining. Men are positioned as having to be strong, brave, and stoic in all situations including in relation to their health. Upholding constraining gender stereotypes, discussions of prostate cancer does not allow men to feel emotional, scared, or sad. Instead men are to ignore the emotional aspect of prostate cancer. They are also to work diligently to hide their disabilities and the effects of prostate cancer and “battle” as strong “warriors” (Courtenay, 2000). Men are also positioned as being incompetent with regard to their health as they must rely on women to push them to seek help and to care for their prostate. We point this out not to say that women should not be involved in men’s health as partner, and family support is important in prostate health. Rather, men are positioned as unable to help themselves and uninterested in their own health, whereas women are positioned as responsible for men’s health improvement. This disregard and incompetence for health and their well-being is a demonstration of hegemonic masculinity as it differentiates men from women and masculinity from femininity (Courtenay, 2000). For men’s health, this is problematic as prescribing to hegemonic masculinity affects how they do and understand health, whereas ways of “doing gender” and doing health outside of these ideals are silenced.

The findings of this research are in fact not unique. Prostate cancer is continuously constructed in relation to hegemonic masculine ideals and male sexuality in differing media including magazines, newspapers, and in television reports. This includes discussions of manhood, impotence, and sexual function (Clarke, 1999) as well as a threat to masculinity (Haplin et al., 2009). This also includes the emphasis on the “good fight” (Clarke, 1999, 2004; Haplin et al., 2009; MacKenzie et al., 2007), the importance of early detection (Clarke, 1999, 2004; Haplin et al., 2009; Hoon, 2005; MacKenzie et al., 2007), and the creation of the male only brotherhood (Clarke, 1999, 2004; Haplin et al., 2009; Hoon, 2005).

Why do the popular news magazines reflect common prostate cancer discourse? We can answer this question by looking at the ownership of the magazines studied. Each magazine is one of many media publications produced by large media conglomerates. For instance, Time Magazine is owned by AOL Time Warner, one of the largest media companies as they own CNN, Fortune magazine, as well as 33 other titles (Time Warner, 2012). As part of media conglomerates, each magazine is a brand and a brand that is part of a larger media company. What is published and discussed in each magazine is linked to the image and brand of each company where the focus is on circulation and profit. The goal in producing each magazine is ensuring that what is published throughout the magazines will make a profit but will also keep advertisers interested in advertising in the pages of the magazine. What is published, in part, reflects this goal.

We also must consider where the magazines are created. All magazines are part of mass media. The magazines are not separate or outside of societal norms as mass media. Instead, the magazines are reflexive while reinforcing and reproducing dominant ideologies and culture. These ideologies, related to prostate cancer, include ideals and performances related to hegemonic masculinity, traditional femininity, and heteronormativity, as well as the responsibilization of health (Clarke, 1999; Lorimer & McNulty, 1991). Those writing the articles are also individuals who live and write within Canadian and American society. As such, the context in which the articles are written is our North American society where certain understandings of gender ideals and performances, race, and health are viewed as normative. Such understandings are thus found within the articles and are not questioned.

Audience can also help us understand why the magazines reflect common discourse. The average cost per issue is $4.96; Newsweek is the cheapest ($3.95), and Maclean’s is the most expensive ($6.95). With the readership (see Table 1) and the cost in mind (see Table 2), the audience of the magazines are middle- to upper-class individuals. Since this is the case, the magazines are created with the audience in mind where the content represents and also caters to the lifestyle of the audience—middle-class lifestyle and ideologies. This means that the magazines present middle-class ideals about family, sexuality, race, health, and gender. With this then, what is found in the magazines and in the articles on prostate cancer are written for a middle-class audience with middle-class lifestyle and ideals.

Table 1.

Audience Characteristics.

Magazine	Average age of reader	Male/female in %	Education	Household income, $	Occupation
Maclean’s	Between 25 and 49	—	Highly educated	—	—
Newsweek	49	56/44	73% are college educated	5 million readers have income of $100,000 or more	4.4 million business professionals
The Saturday Evening Post	50+	48/52	College educated, some postgraduates	—	—
Time Magazine	47.8	53/47	13,000 college grads	$74,951; 6,000 readers $100,000+	Professionals

Note. Information is gathered from each magazine’s Media Kit (Maclean’s, 2013; Newsweek , 2012; Saturday Evening Post , 2013; Time Magazine , 2013). Some magazines provide more information on their readers than others.

Table 2.

Newsstand Price and Number of Issues per Year Published for Popular News Magazines.

Magazine	Newsstand price	Number of issues per year	Mean ( $\overline{x}$ ) cost
Maclean’s	$6.95	Weekly, 56 issues	$4.96
Newsweek	$3.95	Weekly, 56 issues
The Saturday Evening Post	$3.99	Bimonthly, 6 issues
Time Magazine	$4.95	Weekly, 56 issues

In the popular news magazines, intersexed, transgendered, or anatomically male individuals who identify as other identities are silenced as their experiences, views, and understandings of prostate cancer are unaccounted for throughout the articles. In addition to this, homosexual, bisexual, queer, and any other non-heterosexual identities are not represented or discussed in any of the articles. Masculinity is also limited as expressions and performances of masculinity that are outside of hegemonic masculinity are also not represented or considered within discussions of prostate cancer (Courtenay, 2000). It is true that the magazines under study have a specific audience—middle class, White, heterosexual—but while this is the case, what this tells us is that what is “popular” and what is “mainstream” does not include ideals, performances, or identities outside of these very constraining norms. As this research explored popular news magazines, future studies on prostate cancer should consider other magazines that discuss prostate cancer (African American magazines, health magazines—see the appendix for full list).

Discussions of prostate cancer are also limited to the assumption that men do not face health barriers and have access to health services. Health barriers include costs, availability of services, fear, racism, discrimination and distrust of the medical system, differences in language (Clarke, 2010), transportation issues (Dilorio et al., 2011), and employment (Pivnick, Jacobson, Blank, & Villegas, 2010). For instance, this includes poverty as men may not have the ability, because of financial restrictions, to afford testing. For becoming educated and knowledgeable about prostate cancer, men may not have access to sources and doctors. With diet and exercise, men may not have access to or funds for nutritional foods and may not have time to exercise or the extra finances to afford gym membership or equipment. As this is not included in the discussions, the men’s social realities are ignored.

The articles completely ignore the experiences of minoritized and racialized groups and the ways in which such oppression affects health. The articles do not take into consideration the undeniable links between health, racism, discrimination, oppression, social exclusion, and stigma. In ignoring such links, the daily realities of racialized men are dismissed. Thus, the institutional and societal factors that add to and help create health inequalities are made invisible. Social barriers include poverty linked to racism, and the historical and present day segregation affects the health and health care access of minoritized men. Transportation issues and residing in neighborhoods that are not within close proximity to medical centers have been cited as a difficulty in seeking care (Dilorio et al., 2011). Working multiple jobs or having long hours as well as employment has also been found to interfere with individuals’ ability to make appointments and acquire medications (Pivnick et al., 2010).

Racial discrimination within the health care system from doctors, nurses, and other providers has also been cited as a barrier to health for many individuals. It has been reported that racialized individuals have experienced misdiagnosis, late diagnosis, improper follow-ups, and incorrect care (McGibbon et al., 2008) that have led to the distrust of the health care system and health care providers (Dilorio et al., 2011). Stigma of disease, the daily experiences of racism that affect health, social mobility, and education is also invisible (James, 2009). By not discussing such realities, the popular news magazines serve to reproduce rather than question and critique health inequalities, hegemonic masculinity, male sexuality, heteronormativity, and racism.

The question now becomes: Why are these inequalities not present within the articles? Such inequalities and discussions of these inequalities are not found within the articles because of the power hegemonic masculinity and heteronormativity hold within North American society. The articles reflect dominant ideals and performances of sexuality and gender. Thus, what is understood to be significant with regard to the testing, treatment, and recovery of prostate cancer is linked to dominant ideals and the larger social structure. The power of racism within society and the everyday political, social, and economic lives of individuals are overshadowed by hegemonic masculinity and heterosexism. Thus, in this way, the articles have favored heteronormativity and hegemonic masculinity, disregarding racism, discrimination, and inequality based on sexuality and gender, rendering health inequalities silent. Thus, pseudo-equality is constructed as the articles create false equality, which includes equality based on race, gender, and sexuality. This occurs as the magazines do not challenge power relations but instead ignore inequalities and the realities of men. By ignoring such realities, there is a lack of recognition of health barriers, which leads to the construction of a false reality.

For research on prostate cancer, studying popular news magazines is important as such research provides insight into the normative understandings of prostate cancer, health, and gender. Although the opinions and experiences within the magazines do not reflect all experiences or understandings of prostate cancer within any given community, studying the magazines possibly provides us with an understanding of some of the experiences and understandings of health. Media in general does have a powerful influence on the ways in which individuals construct their health. Although this study cannot comment on how the article can affect individuals and their prostate experiences, by understanding what information individuals have access to, medical professionals and health researchers can work to foster social, political, and economic change.