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6 March 2003
Testicular Cancer Self-Examinations Rarely Done
by George Atkinson

A self-exam for testicular cancer takes maybe a minute to do and about that much time to teach but most often, neither happens, according to a study published in the March issue of Pediatrics.

An electronic survey completed by 129 pediatric or pediatric/internal medicine residents at two teaching programs in the United States showed that 29 percent of the male residents performed monthly self-exams and that 40 percent of all the residents taught the exam to their 12- to 21-year-old patients, said the study's lead author, Dr. Joel S. Brenner, adolescent medicine and sports medicine specialist at the Medical College of Georgia.

The most common reason male residents cited for not doing their own self exams was they simply forgot; the reasons they cited for not teaching it to their patients included a lack of time and not thinking about it, Dr. Brenner said.

"Testicular cancer is an important public health problem that needs to be addressed," Dr. Brenner writes. "The only known risks are all predetermined; therefore, a focus on earlier diagnosis and treatment through (education and) regular testicular self-examinations is indicated."

He noted a general need to increase public and physician awareness about testicular self-exam; his study showed that 88 percent of the residents were taught how to teach breast self-exams compared to 41 percent who were taught how to teach testicular self-exam.

Testicular cancer has been on the increase, rising 42 percent in the past 25 years. Today it accounts for 20 percent of cancers diagnosed in males age 15 to 35, making it the most common cancer in that age group. In addition to the target age group, risk factors include an undescended testes, being Caucasian - it's five times more common than in blacks - and family history.

Awareness of the disease and the self-exam techniques to help detect it early are low among those at risk, Dr. Brenner said. The disease, which often presents as a painless mass, has a five-year survival rate of 96 percent overall; as with all cancer, the survival rate is significantly lower when the disease is diagnosed late.

"You do a couple of things by teaching testicular self-exam to adolescents and young adults," Dr. Brenner said. "One is, they might find something abnormal and they might also learn more about their bodies and become more responsible for their health," Dr. Brenner said of a population of young men with an established reticence to go for regular checkups. In fact, many of the pre-participation sports physicals he gives young men at the MCG Sports Medicine Center are the only doctor's exam they get all year. "If I don't see that patient and examine him and teach him how to do a self-exam, he might never get examined," said Dr. Brenner, who is director of pediatric and adolescent sports medicine at MCG.

Monthly self-exams are recommended particularly for those with one or more risk factors. But his survey of the two training programs, one in the Southeast and another in the Southwest, showed that less than half the residents teach the techniques. However, he noted the encouraging finding that senior-level residents were four times more likely to teach self-exams than first-year residents: 51 percent compared to 21 percent. Also, 61 percent of the residents said they examined themselves at least every three months, compared to 29 percent who examined themselves at the recommended monthly interval.

"Confidence in performing a testicular examination, confidence in teaching (testicular self-exam) and knowing someone with testicular cancer were the most important factors related to teaching information that could be used to design an educational intervention to increase physician promotion of (this exam) and ultimately increase young males' (testicular self-exam) practice, " Dr. Brenner writes.

In fact, it was his own experience with a close college friend getting testicular cancer that raised his awareness, prompting him to choose the topic of self-exam for a lecture he gave to his fellow residents years ago. "Before that, I was never taught about it. We don't get a lot of experience and education regarding male reproductive health," he said.

A larger study that includes more residency programs, including some in family medicine, likely would be a good next step to see if his study results are generalizable, Dr. Brenner said, noting that his study was the first of its kind. The next step would be designing educational programs to ensure that residents are knowledgeable and confident performing and teaching the simple exam, he said.

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