Is testicular self-examination a waste of time?

Testicular self-examination is turning men into “ball-watching neurotics” – that’s the view of Keith Hopcroft, a GP from Essex in the United Kingdom. It’s unnecessary, he explained recently in the British Medical Journal, because it won’t necessarily detect cancer and it needlessly induces anxiety.

So, is it time to stop groping your gonads – or to start?
Testicular cancer might be a rare disease, diagnosed in about 690 Australians each year, but it’s the second most common cancer in men aged 18 to 39.
The cure rates, however, are among the highest of all cancers, with about 95% of men surviving testicular cancer and going on to live full and active lives – even in advanced cases.
The usual symptom is a hard lump in either testis. The lump can be painful or tender in around one in ten men. Other lumps can also be found in the scrotum, outside the testes, but these are most likely non-cancerous.
As the causes of this cancer are largely unknown, many clinicians recommend testicular self-examination as a means of early detection, particularly in men at higher risk due to undescended testes in childhood, previous testicular cancer or family history.
Testicular self-examination involves feeling the testes, one at a time, using the fingers and the thumb. It’s normal for one testis to be slightly bigger than the other and the left testis often hangs lower than the right.
To date, there’s no evidence to suggest that death rates are reduced by testicular self-examination. A randomised trial to assess this question would need to be very large, given the low incidence of testicular cancer, and such a study is unlikely to ever happen.
Nonetheless, there is no evidence that this practice causes harm and Dr Hopcroft’s recent comments that it could cause obsessive testicular checking or trigger “incapacitating anxiety” are unfounded. In fact, most studies have shown rates of testicular self-examination are low, although there has been some increase in recent years, possibly due to greater awareness of testicular cancer.
The benefits of early detection of testicular cancer – before it has spread – are a higher survival rate and a reduced likelihood of toxic treatments, such as chemotherapy or major abdominal surgery. Surely that’s worth checking for.
There’s no need for GP-based screening for testicular cancer, but self-examination can help educate young men to identify the normal feel of their testes so they’re aware when there is a change in consistency. Most lumps found in the testes will be cancerous, but other lumps in the scrotum are often benign. If men understand the feel of the normal scrotal structures, they may be able to distinguish between these differing types of lumps.
A key issue is that while some men will present with pain, many men delay seeking a medical opinion due to embarrassment or other factors. Some men will wait until their testicle is the size of a grapefruit before seeking medical attention – and that has to change.
Male sexual health is a significant part of overall good health and the male reproductive system plays a role in many areas of well-being. The more men know about their bodies – the way they work and how to check on the “bits below the belt” – the better.

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