Testicular Self-examination Research Articles

How worrisome is testicular microlithiasis?

Anecdotal reports of men developing testicular cancer after previous identification of microcalcifications on ultrasound generated significant concern in the literature about the relationship of testicular microlithiasis and testis cancer. Until 2001 little prospective data were available on the prevalence or natural history of testicular microlithiasis in the healthy male population. Testicular microlithiasis is present in 5.6% of the male population between 17 and 35 years of age (14.1% in African Americans), far more common than testicular cancer (7:100,000). The majority of men with testicular microlithiasis will not develop testicular cancer. Previously recommended surveillance regimens using ultrasound, tumor markers or testicular biopsy are too costly and do not offer an improved outcome over testicular self-examination. Testicular microlithiasis is common and while microcalcifications do exist in roughly 50% of germ cell tumors the majority of men with testicular microlithiasis will not develop testicular cancer. Increased emphasis on testicular examination is the recommended follow up for men identified with testicular microlithiasis.

Current management strategies for testicular microlithiasis

The association of testicular microlithiasis with testicular tumor and the management of incidentally detected testicular microlithiasis have generated a great deal of interest. We review the current literature on testicular microlithiasis with regard to its association with testicular tumor. This association seems complex. The available data suggest that men with incidental findings of testicular microlithiasis but who have otherwise normal testes are at low risk of developing testicular cancer. The only follow-up recommended is regular testicular self-examination. Testicular microlithiasis is, however, associated with a high risk of developing testicular malignancy in men with subfertility, history of contralateral testicular tumor or history of cryptorchidism. Regular testicular self-examination is recommended for follow-up of high-risk patients, but the role of surveillance with serial ultrasonography and measurement of tumor markers is still not clear.

Prepubertal Orchiopexy for Cryptorchidism May be Associated With Lower Risk of Testicular Cancer

Current indications for orchiopexy are to decrease the risk of infertility and to facilitate testicular self-examination. Although the increased risk of germ cell cancer in cryptorchid testes is undisputed, it is unclear whether orchiopexy affects the natural history of testis cancer development. We hypothesize that early orchiopexy is protective against subsequent development of testicular germ cell cancer. We conducted a systematic review and meta-analysis of the literature. Studies pertaining to cryptorchidism and testicular cancer risk were retrieved by searching MEDLINE, BIOSIS and the Cochrane Library, using cryptorchidism as a keyword, combined with treatment, orchiopexy, testis and cancer. For data extraction exposure was dichotomized to orchiopexy before or after age 10 to 11 years, while outcome was defined as the development of testicular germ cell cancer. Summary risk measures were calculated using the random effects model. Four studies met our criteria. Review of all studies revealed an increased risk of testicular cancer if orchiopexy was delayed until after age 10 to 11 years or was never performed. Odds ratios ranged from 2.9 to 32.0. Meta-analysis showed that testicular cancer was nearly 6 times more likely (OR 5.8 [1.8, 19.3]) to develop in men in whom orchiopexy was delayed or was not performed, compared to those in whom it was performed early. Prepubertal orchiopexy may decrease the risk of testicular cancer. Thus, early surgical intervention is indicated in children with cryptorchidism. These findings suggest that the testicular environment, as well as underlying genetics, may have a role in testicular carcinogenesis.

Testicular self-examination: the person with learning disabilities

People with learning disabilities are at just as much risk as the general population are of contracting cancer. Mainstream men's healthcare needs are often neglected and this is also true for men who have learning disabilities. Testicular self-examination (TSE) is seen as an important activity that men should be taught to detect any early changes that may be signs of physiological significance. While testicular cancer is rare, its incidence is rising. In the majority of cases of testicular cancer, over 90% are curable (Cancer Research UK, 2002). TSE, for the purposes of this article, is seen as an activity that can be carried out independently (by the man himself) or with the assistance of another person (for example, carer or partner). This article discusses the importance of TSE and, in particular, with men who have a learning disability.

292: Educating Our Youth: Adolescents and Testicular Self-Examination

292: Educating Our Youth: Adolescents and Testicular Self-Examination

Testicular self-examination: change in rates of practice in European university students, from 13 countries, over a 10-year period

Background The objective of this study was to compare testicular self-examination (TSE) practice in 13 European countries over a 10-year period. Testicular cancer predominantly affects young men. It is rare but on the increase and is most common in Caucasian ethnic groups living in industrialised nations, particularly northern Europe. Stage and prognosis are related to early diagnosis and TSE has been advocated to help achieve this. Over the last 15 years there have been efforts to increase disease awareness and self-examination practice. Recent reductions in patients’ delay in seeking help have been attributed to the success of this education, although no evidence has been available to substantiate this claim. Methods Data from two successive international surveys in male student populations in Europe ( n = 4322, n = 4358) carried out in 1990 and 2000, respectively, are described. Results Although TSE practice rates are low, there have been significant increases over this 10-year period. Conclusions Increased TSE may reflect greater awareness of testicular cancer and could contribute to more timely help-seeking.

Testicular self-examination: a test of the health belief model and the theory of planned behaviour

The aim of this study was to test the utility and efficiency of the theory of planned behaviour (TPB) and the health belief model (HBM) in predicting testicular self-examination (TSE) behaviour. A questionnaire was administered to an opportunistic sample of 195 undergraduates aged 18-39 years. Structural equation modelling indicated that, on the basis of all the fit indices, the TPB model was the better model, however, the quality of the models was very similar. The TPB explained 50% of the variance in intention and 22% in behaviour while the HBM (with self-efficacy) accounted for 56 and 21%, respectively. Self-efficacy was the most important predictor of TSE behavioural intention across both models. These findings contribute to the growing literature on the testing of multiple models in the health psychology domain.

Promoting awareness and practice of testicular self-examination

To evaluate the efficacy of a health promotion initiative on men's knowledge of testicular cancer and self-examination rates. A quasi-experimental, pre- and post-test questionnaire study of men at 14 workplace and leisure sites across two primary care trusts was undertaken: ten experimental sites received the intervention and four acted as a control. Men at all 14 sites were given a pre- and post-test questionnaire. Of the 835 pre-test and 835 post-test questionnaires distributed, 518 (62.0 per cent) and 356 (42.6 per cent) were respectively returned for evaluation. In the intervention group, the median total knowledge score increased from three points (interquartile range: 2,4) at baseline to four points (interquartile range: 2,4) at post-test. However, no statistically significant change was observed in the control group. Post-intervention, the percentage of test participants examining their testicles regularly increased from 58.4 per cent to 68.3 per cent, while levels among control peers did not significantly alter. This evaluation highlights the potential of using a low-cost initiative which targets innovative venues to improve men's knowledge of testicular cancer and rates of self-examination. Longer-term follow-up may be required to determine whether such increases are sustained.

Promoting awareness and practice of testicular self-examination

Promoting awareness and practice of testicular self-examination

Testicular Cancer and Testicular Self-examination

The main objective of this study was to assess the knowledge of and attitudes toward testicular cancer (TC) and the prevalence of testicular self-examination (TSE) among senior high school male students in Sweden. Another aim was to describe to what extent the students had received information about TC and TSE prior to this study. Seven hundred twenty-seven (70.7%) male students (M = 17 years) completed a 60-item questionnaire, encompassing background characteristics, information, knowledge of and attitudes toward TC, and prevalence of TSE practice. The results showed that most students had never heard of TC or TSE, had limited knowledge of common symptoms, and had hardly ever practiced TSE. The most frequently reported information source on this topic was the mass media. Most of the students considered TC to be a serious disease and were afraid of getting it. Thus, there is a need for imparting health education with respect to this subject, information that could preferably be included when promoting health in school settings and during enlistment to the military services. This investigation is the first part of an intervention study aiming to describe the effect of different educational materials on male students' knowledge of TC and their practice of TSE.

Testicular cancer awareness and self-examination among adolescent males in a community-based youth organization

Background Testicular cancer (TC) is the most common neoplasm affecting males between 15 and 35, and testicular self-examination (TSE) has been recommended for early detection. Studies have found that young adult men have poor awareness of TC and low rates of performing TSE, but little research has examined adolescents. Methods In a comprehensive survey of health behaviors among adolescent boys ( n = 213, mean age 15.4 years) who participated in a community-based youth organization (Boy Scouts of America), we assessed whether respondents had heard of TC and the frequency of performing TSE. Results Nearly 73% of scouts had heard of TC, but only 10.3% performed TSE at levels consistent with current recommendations (10 or more times per year). Compared to whites, blacks were less knowledgeable about TC and less likely to perform TSE. Knowledge of TC also was associated with participation in physical education classes and the intention to graduate from college. TSE was associated with greater health care access and the use of personal flotation devices during water activities. Conclusion TSE is underutilized as an early cancer detection tool. Efforts are needed to increase TC knowledge among black adolescents and to integrate TSE education with promotion of healthy behaviors in community organizations.

Encouraging testicular self-examination by men

Paula Lowson looks at the importance of raising men's awareness of testicular cancer and testicular selfexamination and considers the practice nurse's role

Barriers Identified by Swedish School Nurses in Giving Information about Testicular Cancer and Testicular Self-Examination to Adolescent Males

The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that about 6% of the school nurses had provided information on TC and 9% on TSE; however, the majority was open to presenting such information. The major reason reported for not providing this guidance was insufficient knowledge about the subject. The nurses who had given information were knowledgeable about both TC and TSE and more often informed young men about TC and TSE, whereas those who had only received information about TC were not as likely to provide information about TC or TSE. The results of this study highlight the need to educate school nurses about TC and TSE so they can include this information in their health teaching to adolescent males.

Development of the self-efficacy for testicular self-examination scale

Background: Men between the ages of 20 and 34 years are at highest risk for testicular cancer yet many lack knowledge and confidence in performing self-examination. The Self-Efficacy to Perform Testicular Self-Examination Scale (SEPTSES) is a 7-item questionnaire to be completed by men, which is designed to measure their confidence in self-examining their testicles. The purpose of this methodological study was to determine the validity and reliability of this self-report measure. Methods: Content validity of the scale and clarity of items were established with a panel of experts. The SEPTSES and three valid scales of related constructs were completed by two samples of men (homeless [ n = 150] and non-homeless [ n = 156]) aged 18–34 years. Results: A single factor explained 51.5% of the variance of the scale and Cronbach's alpha was satisfactory ( a = 0.84). Construct validity was further supported by significant correlations with the other three scales; further support was established by a significant difference in mean scores between the two samples [ t (303) = −5.44, p < 0.001]. Conclusion: The SEPTSES is a valid, unidimensional scale and it can be used in further research and in clinical practice as an assessment of this aspect of men's health.

Barriers Identified by Swedish School Nurses in Giving Information about Testicular Cancer and Testicular Self-Examination to Adolescent Males

The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that about 6% of the school nurses had provided information on TC and 9% on TSE; however, the majority was open to presenting such information. The major reason reported for not providing this guidance was insufficient knowledge about the subject. The nurses who had given information were knowledgeable about both TC and TSE and more often informed young men about TC and TSE, whereas those who had only received information about TC were not as likely to provide information about TC or TSE. The results of this study highlight the need to educate school nurses about TC and TSE so they can include this information in their health teaching to adolescent males.

Adolescent survivors: A secondary analysis of a clinical trial targeting behavior change

The late effects of radiation and chemotherapy increase childhood cancer survivors' risk of chronic health problems. Survivors' behavior is important in modifying this risk, yet adolescent and young adult survivors fail to engage in important health-promoting behaviors and frequently practice high-risk behaviors. This secondary analysis re-evaluated a multi-component behavior-change intervention that had previously demonstrated no impact in adolescent survivors of childhood cancer. The parent trial compared 132 adolescent survivors in the intervention arm with 135 in the standard-care arm at baseline and at 1 year for disease and treatment knowledge, perception of late effects risk, and the frequency of health-risk and health-protective behaviors (combined as a single summative measure). In contrast, the secondary analysis examined each of the 14 behaviors separately. Additionally, an analysis of covariance (ANCOVA) was conducted to examine the change in health behaviors while statistically controlling for age, gender, and the wide variation in baseline behaviors. Knowledge (P = 0.038), breast self-examination (BSE) (P < or = 0.0001) and testicular self-examination (P = 0.004) increased, as did perceptions about the need to change behavior (P = 0.004) and the effort needed to stay healthy (P < or = 0.0001). In the treatment group, junk food consumption decreased (P = 0.052) and smoking abstinence was maintained (P = 0.088). Significant interactions between gender and treatment group were demonstrated. Health-risk and health-protective behaviors cannot be effectively combined in a one-dimensional measure. Gender and age influence the impact of interventions targeting health behavior in survivors. Future trials should include observation of the patient-clinician encounter, more complex sampling methods, and pre-trial knowledge of the distribution of the study behaviors.

The Adolescent Varicocele

Just as all adolescent males should be educated by their primary care physicians about testicular self-examination and the symptoms of testicular torsion, they should also be routinely examined in the upright position. In this issue of Pediatrics , Salzhauer et al1 report the potential advantages of the early recognition and treatment of the adolescent varicocele. The observation that varicoceles affect ipsilateral testicular growth and that this growth arrest can be reversed reportedly dates back to Bennett in an article in The Lancet in 1889. However, this information was apparently lost, and it was not until 1977, when Lipschultz and Corriere2 noted progressive ipsilateral testicular volume loss in adults with varicoceles, that attention became refocused on this problem. Based on their report and the fortuitous observation in an adolescent patient with a varicocele of a significantly smaller left testis as compared with the right, Kass and Belman3 prospectively compared testicular size before and after varicocele ligation. Testicular “catch-up” growth occurred in 80% postoperatively. Subsequently, as noted in the article by Salzhauer et al,1 this has been repeatedly substantiated. However, satisfactory evidence that fertility is improved … Address correspondence to A. Barry Belman, MD, MS, 111 Michigan Ave NW, Washington, DC 20010. E-mail: abbelman{at}cnmc.org

Encouraging young males to perform testicular self‐examination: A simple, but effective, implementation intentions intervention

The objective of this study was to examine the effectiveness of a simple psychological intervention known as 'implementation intentions' to promote performance of testicular self-examination (TSE) in a sample of young males. A prospective, randomized controlled design measured knowledge of testicular cancer, prior experience with TSE and intention to perform TSE within a 3-week period. Participants in the intervention group were instructed to formulate specific plans for when and where they would perform TSE. Three weeks later, a second questionnaire assessed self-reported performance of TSE during the study period and future intention to perform TSE. One hundred and fifty-nine male undergraduates aged between 18 and 35 were assigned, at random, to an intervention or non-intervention group. Men over 35 were excluded so that the sample reflected the highest risk age group for testicular cancer. Just under half the original participants (76/159) completed the study. We measured performance of TSE and future intention to perform TSE. Responders and non-responders did not differ on any of the measures assessed at Time 1. At Time 2, 30 (65%) participants in the intervention reported performing TSE compared with 12 (40%) in the control condition, and chi-squared analyses revealed that the difference was significant. The implementation intentions intervention procedure, which encourages the use of environmental and contextual 'cues' to prompt a desired behaviour, appears to offer a promising strategy for encouraging the performance of TSE.

Testicular Seminoma 16 Years After Treatment for CNS Germinoma

Most patients with intracranial germinomas will be cured and become long-term survivors. Physicians caring for these patients should recognize that these patients may be at risk for disease-related and/or treatment-related late sequelae. We report the case of a 27-year-old man who developed testicular seminoma 16 years after treatment for intracranial germinoma. Like their testicular cancer counterparts, long-term survivors of intracranial germinomas may have a susceptibility to develop a subsequent germ cell tumor. These patients require lifelong medical follow-up and should be encouraged to perform testicular self-examination at the appropriate age.

Controversies in male adolescent health: varicocele, circumcision, and testicular self-examination.

The authors review three common clinical controversies encountered by primary care providers of adolescent males: management of varicoceles, the role of circumcision in the acquisition and transmission of sexually transmitted infections, and the value of teaching testicular self-examination. Recent findings in adolescent varicoceles have advanced knowledge regarding the cause of varicoceles, the mechanism by which they may lead to infertility, new screening methods, and optimal surgical management. Accumulating evidence shows circumcision to be protective against acquisition and transmission of sexually transmitted infections, and preliminary work also indicates the potential for protection against the spread of AIDS in Africa. Testicular self-examination remains an unproven screening modality that is suboptimally performed by at-risk patients. This review updates the provider on these topics and clarifies issues involved in these controversies