The U.S. Preventive Services Task Force (USPSTF) recent reaffirmed their recommendation statement for screening for testicular cancer.1 In accordance with the USPSTF 2004 decision, the Grade D recommendation is against screening for testicular cancer in adolescent or adults males.2
The Grade D recommendation is not only improper but may serve as a disservice and conflicting message to those most at risk for testicular cancer. More appropriate would have been a Grade I recommendation indicating that there is insufficient evidence to assess the balance of benefits and harms of the service. Recent reviews of the evidence for testicular cancer screenings have indicated that no studies have been done to determine the effectiveness of testicular self-examination or clinical testicular examination in reducing mortality from testicular cancer.3 This review also based their “good evidence” of rare but serious harm on opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.3 Although based on personal experience, I am unaware of serious harms from a scrotal ultrasound; invasive procedures, such as transscrotal biopsy, have been condemned and false-positives on the ultrasound are minuscule so I am not so assured that the “risks” have not been overestimated. I would be curious to see the data on the risks.
Looking at the above statements reveals that there is indeed no evidence available to even make a recommendation about screening for testicular cancer. The USPSTF recommendation, while excluding patients with a history of crypto-rchidism, failed to make recommendations based on other patients at higher risk for testicular cancer such as Caucasians or more specifically Caucasians between the ages of 15 to 34 years.
Organizations, such as my own, the Testicular Cancer Society, advocate self-testicular exams as a way for men and or their partners to become aware of any changes in their testicles and of testicular cancer awareness in general.4 With only 6 cases per 100,000 men per year and 350 deaths per year due to testicular cancer it is virtually impossible for any study to be designed to show a reduction in morbidity or mortality due to testicular cancer screening. However, it is reasonable to assume that self-examination with previous knowledge of one's “normal” testicles verses serendipity is going to aid in early detection. It is also well known that early stage diagnosis leads to better outcomes and less treatment burdens.
While I acknowledge that the USPSTF faced a difficult challenge to make screening recommendations for a rare cancer with a high treatment success rate, perhaps the best service they could have done was to remain silent. Their recommendation is now going to become a Herculean Task for awareness organizations to overcome in getting young men to become self-aware of their testicles. The recommendation is made for all men but I think what the public has to remember is what is best for one's self.
I believe each man has to ask themselves two questions:
1.If I get testicular cancer, do I want to find out early when my treatment may just be removal of the testicle or would I like to find out later when I will have to receive rounds of chemotherapy, advanced surgery techniques and possible bone marrow transplants to save my life?
2.Can I take two minutes a month to check my testicles and not be bothered by anxiety and risks with an ultrasound?
MICHAEL E. CRAYCRAFT, RPH
Testicular Cancer Society
U.S. Preventive Services Task Force. Screening for Testicular Cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2011;154:483-486.
U.S. Preventive Services Task Force. Screening for Testicular Cancer: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality; 2004.