1 in 8 men in the UK get prostate cancer, according to the charity Prostate Cancer UK, and the risk of prostate cancer doubles if you're black. It's also the second most common cause of death from cancer for men in the UK, after lung cancer.

Prostate cancer is not always life-threatening, but an early diagnosis can be life-saving. So, for Men's Health Week 2024, I worked with experts at Prostate Cancer UK to visualise how screening for and diagnosing prostate cancer has changed. In short, it's more accurate and safer than before and needn't rely on a chance conversation to trigger a discussion—you can do a 30s online check for your prostate cancer risk on the Prostate Cancer UK website right now.

The new way has reduced reliance on the imperfect DRE (digital rectal examination—the test that might come to mind for many). After a suspicious PSA blood test result, you can be referred for a pre-biopsy MRI scan. Clinical trials show that pre-biopsy MRI triage can rule out 27% of men from having an unnecessary biopsy (a biopsy is when a doctor removes some cells for analysis).

Biopsies have also improved and can now be guided by imaging, allowing doctors to identify the areas of the prostate they need to biopsy. It makes it safer and has fewer side effects.

These changes, together, mean fewer unnecessary biopsies and diagnoses that find a higher proportion of clinically significant cancers over clinically insignificant cancers (which may not require treatment), meaning fewer men are at risk of harm from the screening.

Rob Bell, host of the Sketchplanations podcast among many other talents, is an ambassador for Prostate Cancer UK, which supports our "dads, brothers, partners and friends by raising awareness, funding life-changing research, campaigning for change and providing much-needed support." Rob made the connection (this isn't a paid promotion), and you'll hear our discussion with Amy Rylance, Assistant Director of Health Improvement, on how screening has changed in this week's podcast.

Medical research and knowledge is always changing. This sketch has been checked by the team at Prostate Cancer UK based on research. See, for example, the article Fewer Men Face Harm in Prostate Cancer Diagnosis. It's intended to raise awareness, help early diagnosis now or in the future for men reading this, and maybe even save a life. If you have feedback or comments on it, please do write to me: jono.hey@gmail.com

Didn't know when Men's Health Week was? I learned that International Men's Health Week is the week preceding and including Father's Day.

Don't forget, you (or someone you know or love) can do a 30s online prostate cancer risk check online now.

Aside from helping your father avoid prostate cancer, he might like a copy of Big Ideas Little Pictures.

Reference: Most common causes of cancer death

Detecting prostate cancer: old way, new way

Hara Hachi Bu is a saying from Okinawa in Southern Japan that advises people to stop eating when they're 80% full. Okinawa is famous for the longevity of the people who live there.

I learned it from Michael Pollan's excellent book Food Rules many years ago. He shares traditions, including the Ayurvedic in India, the Chinese, and the prophet Muhammad, that all counsel stopping eating earlier than your stomach might be telling you. That, and the German expression, "You need to tie off the sack before it gets completely full."

Hara hachi bu also appears in Dan Buettner's Netflix documentary Live to 100: Secrets of the Blue Zones. Blue Zones are areas in the world with the longest lifespans. Dan Buettner identifies eating to no more than 80% full as one potential factor in Okinawans' long lives.

The more literal translation of hara hachi bu is stomach eight parts (out of ten).

Some other methods to eat less without sacrificing enjoyment include:

Eat slowly so that changes in hunger signals from your stomach have a chance to reach your brain

Avoid distractions such as the TV while eating (when eating dinner, just eat dinner?)

Have a good selection of convenient (stacking) Tupperware for storing leftovers

When drinking tea, just drink tea (I like this sketch—I have it on my wall—so I drew hara hachi bu in the same Ligne Claire style)

Non-stacking Tupperware should be destroyed

It's sometimes misspelled hari hachi bu or said as hara hachi bun me.

Hara Hachi Bu

Box breathing can help us focus on the present, reduce stress and anxiety by lowering cortisol levels, and generally relax and be calm.

Box breathing involves four steps repeated in sequence, each for an equal count:

It's called box breathing or square breathing, as the four equal steps are like the sides of a virtual box. Counting to four is typical, though it can be more or less.

Because of box breathing's simplicity and effectiveness, it's also used by the Navy SEALs—for example, ex-Navy SEAL Mark Divine can lead you through box breathing on video.

I find meditation surprisingly difficult and the steps and simple counting of box breathing help me stay focused and free of distraction as well as any other technique. Even a few cycles of box breathing before a difficult conversation, a public talk, or after a challenging spell with our children helps me stay cool and be better.

Box breathing

I always considered a checklist, a checklist, so I was interested to learn the distinction between two types of checklists: Read-Do and Do-Confirm.

A Read-Do checklist might be prepared in advance for several potential possibilities. You check off the tasks as you do them, like following a new cooking recipe. They may be geared towards helping people understand what they should be doing and in what order and helping them remember key steps in unusual or unplanned scenarios. So, for example, if a plane develops a particular type of rare fault, such as an engine failure, a Read-Do checklist could be pulled out for that scenario. The pilot and crew can use it to make the most of others' past experiences and failures. Even with training, given the situation's relative rarity, and especially if a serious situation might interfere with normal thinking, a Read-Do checklist helps steer the crew to safe outcomes without relying solely on training and memory. The calm security and simplicity of steps of a checklist can be just what's needed.

A Do-Confirm checklist is more of an aid to memory to make sure nothing gets missed. It's a safety net for normal operation catching lapses in memory. In principle, we know what to do, so we run through those steps from experience and memory and use the Do-Confirm checklist at a designated pause point to ensure we didn't miss anything. The WHO Safe Surgery checklist has helped save 1,000s of lives.

Because a simple checklist can never account for every unexpected occurrence in complex environments—for example, healthcare, aviation, building a skyscraper, or software projects—both checklist types can benefit from items that require a communication step. An item can just be to ensure that all those with the relevant knowledge have discussed things. It's a simple and powerful way to improve outcomes across a wide range of unexpected scenarios.

I learned about the simple power of checklists, the two types, and the resistance to adopting them—from Atul Gawande's, The Checklist Manifesto: How to get Things Right.

Two types of checklists: Read-Do, Do-Confirm

It's something I like to keep in mind after a big workout, particularly on the legs — get the weight off them!

Stand sit lie

When studying rates of infections, notably with measles, researchers have seen that in cases where a sufficiently large proportion of a population has been immunised or developed protection against a disease then infection rates also reduce in unprotected members of the population. In other words, the unprotected members appear to receive some indirect protection from the protected members of the population. This effect is known as herd immunity and is a tantalising goal for reducing the prevalence of epidemics.

While appealing in theory this article in Nature provides Five reasons why COVID herd immunity is probably impossible. These include:

Uncertainty around whether vaccinations prevent transmission. For example, herd immunity works when diseases can't be passed between protected members of a population to the unprotected. With COVID-19, vaccines seem to reduce symptoms but may still allow transmission.

It's also challenging to get vaccines evenly to all areas. These combined with complications brought by new variants, immunity fading before widespread vaccination is achieved, and people changing their behaviour — say, mixing more widely — once they've received some protection, means COVID-19 may be more likely to be something we live alongside rather than eradicate.

Herd immunity

The Swiss Cheese Model helps explain why, despite all our best intentions, accidents happen.

Analysis of accidents in large complex systems such as power stations or plane crashes led to an understanding that "no one failure, human or technical, is sufficient to cause an accident. Rather, it involves the unlikely and often unforeseeable conjunction of several contributing factors arising from different levels of the system."

James Reason's Swiss Cheese Model is a memorable visual metaphor that illustrates how each safeguard may contain a latent flaw or hole and that an unfortunate circumstance may result in these holes lining up to disastrous effect. It's also a nice reminder that multiple layers of defence will be more effective, but even with our best efforts, there's still potential for something to go wrong.

Excerpt from Revisiting the "Swiss Cheese" Model of Accidents (pdf), Reason, Hollnagel and Paries, 2006.

Coronavirus example from the Cleveland Clinic.

I learned recently that it's sometimes called the "cumulative act effect".

This sketch, updated and polished, features with a number of others in my book Big Ideas Little Pictures.

The Swiss Cheese Model

Writing this in the middle(?) of the coronavirus outbreak I thought it might be interesting to share these charts, created from the simulations in the excellent Washington Post article “Why outbreaks like the coronavirus spread exponentially, and how to ‘flatten the curve’” by Harry Stevens.

The charts represent different strategies for containment and mitigation of the effects of a contagious outbreak.

Trying to quarantine an area — where it is difficult to attain complete quarantine — delays the effect of an outbreak somewhat, but once released the impact is still significant with a potentially high peak of cases.

Social-distancing — staying away from each other to reduce the chance of infecting others if you are infected and minimise the chance of infecting yourself — in both the bottom scenarios in the simulation manages to both delay the onset of an outbreak and reduce the peak. Not included in this simple simulation is that reducing peak infections in particular helps the healthcare system effectively treat and care for those who are infected, and look after its healthcare workers. When healthcare is not overwhelmed this further minimises both the spread of a disease and fatality rate.

Read the article, run your own simulations, and maybe consider supporting the Washington Post, here: “Why outbreaks like the coronavirus spread exponentially, and how to 'flatten the curve’”.

Disclaimer: I am not a public health professional. These charts are from my results of the simulations in the article and the simulations represent a simplified, though instructive I think, view of an outbreak and these containment methods.

Flatten the curve of an outbreak

In these times, and to be honest, most times, washing your hands well is one of the very best things you can do to keep yourself healthy and free from infections.

You should use soap if you have it; it should take about 20s, and if you follow these steps, you’ll cover pretty much all of the different parts of your hands. In standard, cursory handwashing, it’s very easy to miss what ought to be obvious places to clean, like your fingertips. Then, try to avoid touching taps and door handles on your way out of public places.

I find doing these steps takes about 20s, but to make sure you could also try singing a song segment you like. NPR has some suggestions: Keep flu at bay with a song.

Some other hygiene sketches to bear in mind:

Sneezes and coughs are powerful things — a sneeze can travel up to 8m. So always make sure you do your…

And as a basic rule…pour don’t dip when sharing snacks

The handwashing guidance is from the wonderful NHS.

How to wash your hands

Pour, don't dip when sharing snacks was something I learned for backpacking but it really always makes sense once you think about it.

Pouring onto a hand keeps dirty hands out of the rest of the snacks in much the same way as a drinking fountain manages to be hygienic by shooting out the water.

Pour, don’t dip when sharing snacks

I love this term. From the Japanese shinrin-yoku, it means to soak in the atmosphere of a forest. And I think it’s not too far of an overstatement to say that a walk in Nature is about the closest to a miracle cure we have. There appear to be myriad benefits from simply spending time in Nature. As my sister put it, if it was a drug we’d be prescribing it.

Though we didn’t call it forest bathing at the time it’s definitely some of my happiest memories, like here, here, here, here, and here.

Forest bathing

‘Tis the season for these powerful things. Turns out sneezes can travel up to 8 m, coughs up to 6m and they can linger in the air for up to 10 minutes.

All the more important to make sure you’re doing your Dracula sneeze into your sleeve.

Sneezes and coughs

One of the best virtuous circles. One of my more surprising recent reads has been Novak Djokovic’s Serve to Win about diet, discipline, going gluten-free and physical and mental excellence. The guy certainly knows about excellence and it was neat to learn his philosophy on eating — the book contains recipes — and taking care of yourself including some serious respect for sleep. This sketchplanation is just one of the reason’s why. Since reading it I’ve put an alarm on every night to remind me to respect sleep. Night!

The virtuous cycle of exercise and sleep

What is the difference between venomous and poisonous?

Venomous animals inject venom through bites, stings and the like, though they often avoid it—think snakes, spiders, stingrays, wasps, etc.

Poisoning is when a poison is passively transferred to us through absorbing, consuming or inhaling it—think amphibians, plants, fungi, etc. It might be through touching the skin of a poisonous frog, eating a poisonous animal or breathing in poisonous spores.

Just a few animals manage to be both venomous and poisonous, such as some snakes that inject venom and also have toxic skin from eating poisonous toads.

And a third category you'll know to steer clear of is toxungenous animals that spray, fling or spit toxins toward potential threats. These include the skunk or the aptly named bombardier beetle that sprays acid from its rear.

Fortunately, our instincts are well-trained from centuries of evolution and experience to avoid anything venomous or poisonous, but one day, it may pay to know the difference.

This sketch features in my book Big Ideas Little Pictures

Venomous, poisonous - what’s the difference?

A Dracula sneeze is sneezing into your sleeve at your elbow rather than sneezing into your hands.

The dramatic full Dracula pose is a fun reminder of a more hygienic way to sneeze should you be caught without a tissue. Keeping your hands clean by catching sneezes or coughs in this way helps reduce the chance of spreading cold and flu germs.

However, the CDC’s preferred method for coughing and sneezing is to cover your mouth and nose with a tissue, throw it in the trash and wash your hands.

Dracula sneeze

Seriously, I am not qualified to give medical advice. This is not a recommendation. Seek advice from your doctor. We have been told this from ours several times.

Alternate ibuprofen and paracetamol

We’ve been looking for the right size plates for some time.

Smaller plates help you eat less

If you feel the need to sneeze, some people find that looking at a bright light can help release the urge.

Apparently, it’s called the photic sneeze. I asked BBC Science Focus magazine in the UK what was happening here. They shared that it's called the photic sneeze but also that Science doesn’t really know why. We need to find out.

It happens without fail for our eldest son. Anytime we pause to take a family selfie facing towards the sun, there's a guaranteed sneeze. It used to be a common occurrence that leaving the bedroom in the morning and entering the light would also trigger a sneeze. My niece is also a reliable photic sneezer.

Bright light will free your sneeze

Learned from Joe Smith’s short entertaining TED talk: How to use a paper towel.

Health sketches