"Men lack ... confidence in examining their testicles, especially if they have never been taught the proper technique," study author Dr. Joel Brenner, assistant professor of sports medicine and adolescent medicine at the Medical College of Georgia, told United Press International.
"There is this taboo of talking about testicles, unlike discussion about breasts, female self-examination and mammograms, which are discussed daily on prime-time television and other media," Brenner said. "The Lance Armstrong story has now made talking about testicular self-examination a little more acceptable."
Armstrong, a world bicycling champion and repeated winner of the Tour de France, has publicly discussed his testicular cancer, treatment and recovery.
Testicular cancer rates have been rising, increasing 42 percent in the past 25 years, Brenner noted. At present, it is the most common cancer in males ages 15 to 35 and accounts for 20 percent of diagnosed cancers.
"We are unsure of the reason for the increasing incidence since the only known risk factors are predetermined: undescended testes, age group, Caucasian race (with an incidence rate five times greater in whites than blacks) and personal and family history of testicular cancer," Brenner said. "Other researchers are currently investigating other possible risks factors (such as environmental or in utero factors)."
Monthly self-exams are recommended, particularly for those with one or more risk factors. The disease often appears as a painless mass and, if diagnosed early, has a 5-year survival rate of 96 percent. However, the survival rate is significantly lower if the disease is diagnosed late. After a close college friend was diagnosed with testicular cancer, Brenner said he began to learn about using and teaching testicular self-examination. "Before that, I was never taught about it," he said.
As reported in the March issue of the journal Pediatrics, Brenner surveyed 129 pediatric or pediatric/internal medicine residents at two teaching programs in the United States. He found 29 percent of the male residents performed monthly self-exams and 40 percent of all the residents, male and female, taught the exam to their 12-to-21-year-old patients.
Brenner's research showed 88 percent of the residents were taught how to teach breast self-exams compared to 41 percent taught how to teach testicular self-exams. He also found the most important factors related to the self-use and teaching of the exam included confidence in performing a testicular examination, confidence in teaching (testicular self-exam) and knowing someone with testicular cancer.
Male residents reported forgetfulness as the main reason for not performing self exams routinely, and all residents cited lack of time, as well as forgetfulness, for not training patients to do the self-exam, Brenner reported.
"Testicular examination is supposed to be a part of every routine health examination or check-up and every pre-participation sports examination," Brenner said. "It is very disappointing to hear from so many young men who come in to see me for a sports physical that they have never had their testicles examined before, let alone being trained about the cancer risk and in self-examination. In my experience, the males who perform testicular self-examination are the ones who have been taught it by their physicians with repeated reinforcements."
Noting his survey is the first of its kind, Brenner suggested a larger study of more residency programs -- including those in family medicine -- could constitute the next step in designing educational programs for more effective training of residents. In addition, he said more research could help develop effective mass-education programs about testicular cancer and its early detection.
"Many practicing pediatricians do not focus their medical practices on adolescents or young adults and indeed may forget to do the testicular exam or do not think about doing it even after residency is finished," Dr. Walter Gilbert, acting director of the Adolescent Medicine Division at the Naval Medical Center in San Diego, told UPI. "When a pediatrician sees five-to-10 patients per hour for 8-to-10 hours per day, lack of time may truly play a role."
Gilbert added: "Awareness of the preventive measures adolescent males could use can be promoted by well known people like Lance Armstrong who have survived. National media campaigns, similar to those for Breast Cancer Awareness or AIDS Awareness, may help to increase prevention of this common cancer through the use of a simple, one-minute testicular self-examination."
(Reported by Bruce Sylvester, UPI Science News, in West Palm Beach, Fla.)