Academic journal article International Journal of Men's Health

Testicular Cancer Screening in a Primary Care Setting

Academic journal article International Journal of Men's Health

Testicular Cancer Screening in a Primary Care Setting

Article excerpt

Testicular cancer most commonly affects younger males, and its incidence has increased in recent years. There is, however, a lack of data documenting the level of testicular cancer screening by physicians in primary-care settings in the U.S. In this retrospective study over a one-year period, we looked at the prevalence of testicular cancer screening in 200 males ages 18 to 39 in a university-based clinic in Southeast Texas. Thirty-one (15.5%) participants received a testicular examination. Three participants were asked about testicular cancer risk factors, and three had education on screening (one participant had both, for a total of five). Of the three participants receiving screening education, two were taught testicular self-examination by the physician, while the other one was given written materials on screening. These rates of testicular cancer screening are low. Interventions are needed to help improve patient and physician awareness of testicular cancer screening.

Key Words: testicular cancer, disease prevention, preventive health services, self-examination, male

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Testicular cancer is the most common cancer occurring in males between 18 and 39 years. The incidence of this cancer has increased over time, almost doubling in the last 20 years (Ries, Kosary, Hankey, Miller, & Edwards, 1998). The American Cancer Society (ACS, 2002) estimates that about 7,500 new cases will be diagnosed this year alone. Treatment for this disease has also improved dramatically during this period (Ries, Miller, Hankey, Kosary, Harras, & Edwards, 1994). Despite testicular cancer currently being one of the most treatable malignancies, 400 males will die from this disease this year (ACS, 2002).

The fact that the benefit of testicular cancer screening remains controversial may affect screening rates for this cancer. The major medical organizations differ in their recommendations for screening. The American Cancer Society (ACS) recommends testicular examination by a healthcare provider every one to three years, depending on the patient's age, as part of a general cancer checkup. It also recommends that men practice monthly testicular self-examination (ACS, 1993). The American Academy of Pediatrics (1988) recommends that patients perform testicular self-examination beginning at age 18. The American Academy of Family Physicians (AAFP) and the U.S. Preventive Services Task Force (USPSTF) currently conclude that there is insufficient evidence to recommend for or against routine screening of asymptomatic men in the general population by either physician examination or patient self-examination (U.S. Preventive Services Task Force, 1996; Zoorob, Anderson, Cefalu, & Sidani, 2001). However, the USPSTF does recommend that screening options be discussed with patients in high-risk groups (U.S. Preventive Services Task Force, 1996). Risk factors placing a patient in a "high-risk group" for testicular cancer include a history of any one or more of the following: cryptorchidism (undescended testicle), orchiopexy (surgical correction of the undescended testicle), testicular atrophy (degeneration of the testicle), prior diagnosis of mumps, orchitis (inflammation of the testicle), inguinal hernia, hydrocele (fluid around the testicle), and previous testicular cancer (American Academy of Family Physicians, 1994).

Accurate information on the prevalence of testicular cancer screening in primary care is lacking. Studies examining the prevalence of testicular cancer screening have focused on physician self-reports of their practice of testicular examinations (Misener & Fuller, 1995; Singer, Tichler, Orvieto, Finestone, & Moskovitz, 1993; Sladden & Dickinson, 1995), physician self-reported rates of testicular self-examination (TSE) education (Brenner, Hergenroeder, Kozinetz, & Kelder, 2003; Misener & Fuller, 1995; Sayger, Fortenberry, & Beckman, 1988), or patient self-reported practice of TSE (Katz, Meyers, & Walls, 1995; Khadra & Oakeshott, 2002; Moore & Topping, 1999; Neef, Scutchfield, Edlder, & Bender, 1991; Wardle, Steptpe, Burckhardt, Vogele, Vila, & Zarczynski, 1994; Wynd, 2002). …

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