To promote awareness about testicular cancer, a photographer and filmmaker spent two years traveling across Canada and the U.S. on foot, pushing a giant 6-foot-wide, flesh-colored rubber ball named “Lefty.” Thomas Cantley, 32, who was successfully treated for stage III testicular cancer in 2009, believes it’s important for men to be proactive and do a monthly self-exam of their testicles.
Cantley isn’t the only one using unorthodox methods to champion the cause for regular screening. In November, Willie Geist and Carson Daly, stars of the Today Show, underwent a much-publicized testicular exam by a urologist during a live on-air segment.
Yet routine testicular cancer screening is not universally endorsed. The most recent recommendation made by the U.S. Preventive Services Task Force (USPSTF), released in April 2011, gives testicular cancer screening a grade D—saying it need not be done by self-exam or by a clinician.
No studies have been designed specifically to evaluate the benefits of testicular cancer screening. To make its assessment, the Task Force looked at data from three studies it deemed relevant because they addressed screening in symptomatic men, who would have had an even greater likelihood of having a testicular cancer diagnosis.
“Given the low prevalence of testicular cancer, limited accuracy of screening tests, and no evidence for the incremental benefits of screening, the USPSTF concluded that the harms of screening exceed any potential benefits and recommended against screening,” says Michael LeFevre, a family physician at the University of Missouri School of Medicine in Columbia who chairs the USPSTF.
Testicular cancer is an uncommon disease. The American Cancer Society (ACS) estimates that in 2015 there will be about 8,430 new testicular cancer diagnoses and 380 deaths. About three-quarters of diagnoses are made in men between the ages of 20 and 44.
Unlike many other cancers, a testicular lump is not studied via biopsy. Instead, doctors perform an ultrasound to determine if the lump is solid, and if it is, request a blood test to see if there are tumor markers present that would be indicative of testicular cancer.
Testicular cancer is typically diagnosed at an early stage.
- About 68 percent of men are diagnosed when the cancer is stage I and still in one testicle. For these men, the five-year survival rate is 99 percent.
- About 18 percent of men are diagnosed when the cancer is stage II and has spread to nearby lymph nodes. For these men, the five-year survival rate is 96 percent.
- About 12 percent of men are diagnosed at stage III. For them, the five-year survival rate is 73 percent.
- Testicular cancer staging does not include a stage IV diagnosis.
On its website, the American Cancer Society (ACS) “recommends a testicular exam by a doctor as part of a routine cancer-related check-up.” But they also go on to say, “Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from this cancer. This is why the ACS does not have a recommendation about regular testicular self-exams for all men.”
Even so, some physicians recommend that men perform a monthly self-exam. Daniel Lin, a urologic oncologist at the University of Washington in Seattle, says that even though early detection may not save lives, it may make treatment easier. In addition, “if a patient has more advanced disease, he may not die from it, but he’ll have to undergo chemotherapy or radiation,” he says. In contrast, if it is caught early, it can be treated with surgery followed by careful observation for up to 10 years.
Self-exams are also very benign, says Lin. “They are completely non-invasive, there’s no cost, no real risk, and it’s something that a man can easily do in the shower,” he says.
Scott Eggener, a urologic oncologist at the University of Chicago, agrees. “Unlike other screening tests, where you may find cancers that will never be a threat to a patient’s life, in this case there is no such thing as overdetection,” he says. “Every testicular cancer will become clinically relevant at some point.”
Says LeFevre: “The Task Force understands that many adolescent and adult males will want to continue to regularly self-examine for signs of testicular cancer and consult with their health care providers … [but] there simply isn’t enough evidence showing that current screening methods … are likely to detect testicular cancer at earlier and more curable stages.”
March 26, 2015