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Monday’s medical myth: testicular self-examination is 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…

It’s important men can identify potentially cancerous lumps in their testes. xddorox

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.

A self-examination involves feeling each testis for lumps. jakub_hla

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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24 Comments sorted by

  1. Michael Tam

    Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

    Thank you for your opinion, Prof Frydenberg, but can this really be considered a "myth"? I appreciate that your affiliated organisation Andrology Australia recommends routine testicular self-examination, but this is not the position of the Royal Australian College of General Practitioners ( http://www.racgp.org.au/redbook/9-6 ), nor the US Preventive Services Task Force ( http://www.uspreventiveservicestaskforce.org/uspstf10/testicular/testicupsum.htm ).

    If I've read your article correctly, your…

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    1. Citizen SG

      Citizen

      In reply to Michael Tam

      There may be a case for further study to be undertaken before these conclusions can be made. The references for the RACGP stance on TSE is the American National Cancer Institute who state on their website:

      "No studies have been done to find out if testicular self-exams, regular exams by a doctor, or other screening tests in men with no symptoms would decrease the risk of dying from this disease. However, routine screening probably would not decrease the risk of dying from testicular cancer. This…

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    2. Michael Tam

      Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

      In reply to Citizen SG

      "Although there is no evidence that TSE leads to a reduction in mortality or morbidity i can't find that there is evience that it does not."

      This is true. However, I would argue that widespread population-based interventions (and recommendations for men to routinely perform TSE is an intervention) should be based on evidence rather than "hope". It is widely acknowledged that TSE or any other form of testicular cancer screening is unlikely to reduce mortality.

      My experience as a GP (and yes…

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    3. Stiofán Mac Suibhne

      Contrarian / Epistemologist

      In reply to Michael Tam

      EBM has become a religion. Only the anecdotes of its priests are permisable presumably as they are in communion with the higher EBM truth construct so their non-evidence is evidence. I can't believe you are pushing a line that men should not examine their own bodies. It's too stupid. A sort of EBM-GP post-modern anti-onanistic crusade. Crazy times.

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    4. Michael Tam

      Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

      In reply to Stiofán Mac Suibhne

      The conclusion is not "men should not examine their own bodies".

      The conclusion is "there is no compelling reason why doctors should tell men to examine their testicles on a regular basis".

      See the difference?

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    5. Stiofán Mac Suibhne

      Contrarian / Epistemologist

      In reply to Michael Tam

      You really do need to (re?) read Medical Nemesis. Hard as it me be not everyone wants to live in an iatrogenic dictatorship.

      Do you understand that?

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  2. Clifford Chapman

    Retired English Teacher

    So should a doctor advising me to do this, get the sac?

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  3. Dale Bloom

    Analyst

    I have issues with the photos selected for these types of articles, such as the photo of circular street lamps (or maybe they are sculptures) and a photo of cross-eyed or puzzled man.

    And wording such as “So, is it time to stop groping your gonads – or to start?” Why not, “So is it time to carry out testicular self-examination – or to start”

    The photos and wording could be inferred as mocking the male gender, which is now very common or routine in academic circles.

    The article is quite different to the article titled “Take the pressure down – pregnancy doesn’t have to be so stressful”, which also mentioned perceptions of risk and unnecessary fears.

    https://theconversation.edu.au/take-the-pressure-down-pregnancy-doesnt-have-to-be-so-stressful-5830

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    1. Citizen SG

      Citizen

      In reply to Dale Bloom

      The article is presumably different because it is written by somebody else, in this case a male professor of surgery; whereas the article on pregnancy is written by a female psychologist. You will find that different professions have different norms in academic writing. The articles may have been written for a particular audience and then adapted for this website at a later stage, therefore the tone and style would reflect this.
      Or it could be an academic conspiracy against men. I have a rough feeling which stance you'll barrack for.

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    2. In reply to Citizen SG

      Comment removed by moderator.

    3. Dale Bloom

      Analyst

      In reply to Citizen SG

      My reply will probably be removed as usual, but lines such as "is it time to stop groping your gonads" make the article similar to something out of a newstand magazine, with no reliabilty attached.

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    4. Citizen SG

      Citizen

      In reply to Dale Bloom

      In reply to Dale...if his post is removed this will make no sense....

      The flippant comment 'groping your gonads' does not reduce the reliability of the information in the article. If you object to the tone of the article that is your opinion, if you object to the content on its merit on a factual basis you'll need to do better.

      Perhaps you should look at the content... it is the least misandrist article you have commented on. It's about affirming the health of men.

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Dale Bloom

      Dale Bloom: "I have issues with the photos selected for these types of articles..."

      Well, the article about pregnancy (with which you compare this one) was illustrated with several close-ups of pregnant abdomens, including a naked one. Would it be more equitable if this story were illustrated with a couple of close-ups of men's crotches, and one close-up of a naked scrotum?

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    6. Citizen SG

      Citizen

      In reply to Sue Ieraci

      Sue! Please..... I went visual on that....
      By the way, what did you think of the article?

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Citizen SG

      Sean - a bit ambivalent. I don't see a lot of harm from self-examination because, if a lump is felt, imaging can be done before anything invasive like biopsy.

      Breast self-examination doesn't make women "paralysed with fear" about breast cancer, but having a first degree relative with the cancer might. Overall I think having a feel for what is normal in your body is a good thing.

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    8. Michael Tam

      Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

      In reply to Sue Ieraci

      Ah, but these are empiric questions!

      Does REGULAR breast self-examination (BSE) cause harm? The evidence so far suggests that it does. Women randomised to perform BSE had about twice the rate of benign biopsies compared to the control group (who did not perform BSE). There was no evidence of benefit to breast cancer mortality. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003373/abstract

      If one follows the guidelines for managing a woman with a new breast lump, it is not surprising that many women will end up receive a biopsy: http://canceraustralia.nbocc.org.au/bestpractice/resources/IBS172_theinvestigationofan.pdf

      Even assuming the claim that "having a feel for what is normal in your body is a good thing" is true (sounds reasonable enough), it does NOT support the position for routine BSE (which is a type of self-administered population screening). This is an important distinction.

      Cheers.

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    9. Sue Ieraci

      Public hospital clinician

      In reply to Michael Tam

      You are right, Michael. What I was trying to say was that I don;t see evidence that self-examination makes people "paralysed with fear".

      The issue of mass screening and false positives is a different one (often discussed in relation to prostate cancer and PSA).

      I acknowledge the argument that mass screening of a low prevalence population results in a high rate of false positives, and that this can lead to harm through over-use of invasive biopsy.

      What I meant to say about testicular masses…

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    10. Dale Bloom

      Analyst

      In reply to Citizen SG

      Sean,
      I don’t know of too many men who would grope their gonads.

      There seems to be a reluctance by many men to go to doctors. I don’t know of any reliable research that has been carried out regards this (and I don’t know of much reliable research that has been carried out on men at all), but I would estimate or guess that many men don’t go to doctors because they will be mocked by medical staff.

      The photos and some of the comments in the article are in line with that.

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    11. Sue Ieraci

      Public hospital clinician

      In reply to Dale Bloom

      Dale Bloom - perhaps you don't know much reliable research - but that doesn't mean it doesn't exist. Men's reluctance to seek medical services is a known phenomenon in health care, which is being addressed from various points of view - both the psychology and public health points of view.
      This is easy to find with a net search.

      There are two influences on women seeking health care that are not easily reproducible in men:
      1. Attending regularly for contraceptive ("pill") prescriptions; and
      2. Taking children when they are sick.

      Men also do (2), but not as commonly as women. Recent campaigns have included screening for prostate cancer which, although it has its problems as a screening program, seeks to get men to attend health services.

      If there were generalised role reversal in families, with men taking primary responsibility for child care and contraception, then men might attend health services more often.

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    12. Dale Bloom

      Analyst

      In reply to Sue Ieraci

      Sue Ieraci
      I don't think any reliable research has taken place regards this, but from my observations, there are many single men, and men who have had their children taken from them, who still do not go to doctors.

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    13. Stiofán Mac Suibhne

      Contrarian / Epistemologist

      In reply to Michael Tam

      So in this iatrogenic reality patients will no longer have sensory experiences of their own bodies in case it leads to fearful thoughts or makes them seek healthcare services? If only Ivan Illich had lived to read such crapola.

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    14. Sue Ieraci

      Public hospital clinician

      In reply to Stiofán Mac Suibhne

      Men could still have sensory experiences if they were to spontaneously "grope their gonads", but Dale Bloom doesn't think too many men do that. ;-)

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    15. Dale Bloom

      Analyst

      In reply to Sue Ieraci

      Sue Leraci
      No, I don't think many men grope their gonads. Immediate pain would be felt.

      If testicular cancer is such a rare disease, there is not much necessity for self-examination. Possibly other forms of self-examination would be necessary, such as self-examination for sun spots.

      But that doesn't have much to do with male genitals, and this site does contain quite a number of articles on male genitals for some reason.

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  4. Clifford Chapman

    Retired English Teacher

    Amazingly, I've been given a couple of negatives for my non-rhetorical question, as if that is too extreme a punishment, so should I just call him a 'Nut case'?

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