Breast and testicular self-examinations in cancer screening: a matter of quaternary prevention?

Abstract

Health care includes important preventive attitudes that are divided into four categories: primary, secondary, tertiary, and quaternary. Quaternary prevention refers to the avoidance of the implementation of procedures whose benefits are doubtful and damages are unknown or notorious. Counseling for self-examinations in breast and testicular cancer screenings can fall under the purview of quaternary prevention. However, there is a lack of randomized controlled trials that examine the effectiveness and safety of testicular self-examination. Meanwhile, in two large randomized controlled clinical trials, breast self-examination has been proven to cause harm (anxiety and biopsies to detect benign lesions) as a screening method, with no benefit in terms of mortality rates. Healthcare professionals should be aware that the absence of counseling in this context, paradoxically results in the protection of health, especially with reference to breast cancer screening. It is a simple example of how less is more.