by Nikhil D. Patil
In honor of World Cancer Day, 2013, I wanted to share my own story of cancer survivorship. To read Part I of my story, please click here. I also want to raise awareness of “Movember,” a global advocacy month where men grow mustaches to educate others about important men’s health issues. Focusing on prostate cancer and testicular cancer, the campaign also raises funds for men’s health initiatives including the Movember Foundation, Prostate Cancer Foundation and LIVESTRONG Foundation. For more information about Movember check out: www.movember.com . Remember, Movember only happens once year but testicular cancer happens year round.
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Testicular cancer: the basics
Testicular cancer is a type of cancer where the tumor can be found on either one or both of a man’s testicles. According to the American Cancer Society, approximately 8,590 men in the US will have been diagnosed with testicular cancer in 2012 (1). A man’s lifetime chance of developing testicular cancer is 1 in 270 and when caught early, testicular cancer is extremely curable. While there are no known risk factors for testicular cancer, it primarily occurs in Caucasian males, aged 15-35. Global estimates for testicular cancer are severely underreported and further research is necessary, particularly in middle- and low-income countries, to determine more accurate prevalence rates.
Many cancer-related deaths, especially testicular cancer, are curable when detected early. Despite available screening methods and effective treatment options, about 360 men in the US will have died from testicular cancer in 2012 (1). On a global scale, we cannot know the number of deaths caused by testicular cancer due to a lack of awareness and screening, but we can only imagine that the death rate is much higher.
In this day and age, it is unacceptable that there are still men dying of testicular cancer. To defeat this horrible disease, we don’t need new technologies or new treatment; we need men to be more aware of their bodies and to see a health professional if they think something is wrong. So this begs the question: how can we get (young) men to be more aware about testicular cancer?
Engaging men in healthcare
As men, we’re socially programmed to “act tough” and ignore pain. We think we are invincible. The idea of being afflicted with a chronic disease like cancer, especially at such a young age, seems ludicrous.
When I first started experiencing pain in my groin many years ago, I shrugged it off as nothing. Even when the pain became more frequent last year I tried to tough it out. What’s a little pain after all? Although the possibility of testicular cancer crossed my mind several times (I’m a public health expert after all) I told myself that couldn’t be possible. Cancer happens to other people. Testicular cancer is a “Caucasian” disease. Besides, I don’t even have any family history of cancer. After a while of debating internally, even the most rational person can convince themself to believe anything. “It couldn’t be cancer” eventually became, “it’s not cancer, it’s something else.” When I finally did decide to talk to my father (a physician), it was more out of convenience than any actual concern that something could be wrong.
Maybe one of the first steps to preventing testicular cancer, or at least diagnosing the tumor earlier, is just to dispel the myth that cancer can’t happen to you. Men need to remember that cancer is not selective; when it comes to cancer, you can’t assume that you’re not at risk.
Raising awareness about testicular cancer is not enough though. Men need concrete steps on what they can do to prevent testicular cancer, or at least diagnose it earlier, that doesn’t involve going to see a healthcare provider. Enter: the testicular self-examination.
A testicular self-examination (TSE) is an easy way for men to check their own testicles for any unusual lumps or bumps, one of the first signs of testicular cancer (1). Performing a testicular self-examination is simple. It is recommended that men do this exam on a monthly basis. For specific instructions on how to perform a testicular self-examination or to learn more about other signs for testicular cancer, please check out this awesome resource by the Testicular Cancer Resource Society (2).
If women are constantly exposed to messages around breast cancer and self-exams, why not engage men to promote a global movement of education and screening for testicular cancer?
The pros and cons of testicular self-examinations
The main reason for a lack of support from public health agencies for the promotion of testicular self-exams is the mixed evidence base to support the practice. The US Preventative Services Task Force (USPSTF) actually advises against screening for testicular cancer (3). This conflicting decision by the USPSTF is based mainly on the absence of research assessing the efficacy of TSE and screening because the sample size needed to detect a change in morbidity or mortality outcomes among testicular cancer patients is so large, a study to prove its efficacy is not practical.
Despite this recommendation by the USPSTF, many health professionals, including the American Cancer Society, still advocate for testicular self-exams, particularly among at-risk populations, based on the idea that even if self-exams don’t reduce mortality, they should prevent stage migration (i.e. tumor progression from Stage I to Stage II, etc.) and detect the cancer at an earlier stage (1,4). While late stages of testicular cancer might require extensive chemotherapy, radiation or further surgical interventions, early detection through self-exams or screening can reduce the treatment burden to where an orchiectomy (surgical removal of the infected testicle) might be all that is necessary to improve health outcomes.
I do want to mention that sometimes the mass might be in a location or a size that is not easily detected through a self-examination. My lump was so small that unless the urologist had known where to look with the help of the ultrasound, he might have missed it during a regular exam. While I’m certainly an advocate for self-examinations, if you aren’t able to find a lump but are still experiencing one – or more – of the other symptoms of testicular cancer, please go and see a health professional.
So men, are we going to sit back and let our brothers continue to succumb to this terrible disease? Or are we going to stand up and spread a message of awareness, screening and early detection. The ball is in our court (pun intended).
Nikhil D. Patil, MPH is a graduate from the Department of Maternal & Child Health at UNC-Chapel Hill and is currently serving as a Fellow with Arogya World in Atlanta, GA. For the month of November, he participated in the Movember 2012 mustache challenge to raise awareness about testicular cancer, particularly among Asian Americans. You can follow him on Twitter: @npatil55
REFERENCES
1. American Cancer Society. (2012, May 16). Testicular Cancer Overview. Retrieved from http://www.cancer.org/acs/groups/cid/documents/webcontent/003079-pdf.pdf
2. Testicular Cancer Resource Society. (2012). How to do a testicular self examination. Retrieved from http://tcrc.acor.org/tcexam.html
3. U.S. Preventative Services Task Force. (2011). Screening for testicular cancer: U.S. Preventative Services Task Force reaffirmation recommendation statement. Ann Intern Med. 154: 483-486
4. Craycraft, M.E. (2011). USPSTF reaffirmation of recommendation against screening for testicular cancer – Comment from founder of the Testicular Cancer Society. Oncology Times.