Testicular cancer can strike men at any age. But it is the # 1 cancer afflicting males between the ages of 15 and 35. And it would seem that the younger the demo, the more denial there is about health issues, especially when it comes to cancer.
Testicular cancer can also be something of an assault on the male ego, which can lead to even more discomfort and denial about the subject.
But testicular cancer is usually easily diagnosable and treatable–especially if caught early. So CBS Cares and our partner, Harvard Medical School/Massachusetts General Hospital felt it was an issue that lent itself to a public service campaign. We hope that our campaign may contribute to awareness of the issue and to the efforts of public health experts to overcome embarrassment and stigma which can cost lives.
For the record, we are not literally suggesting that a testicular self-exam be presented to your spouse or partner as the romantic highlight of Valentine's Day (unless of course you want to!). And we believe there is room for other gifts and the self-examination.
But the "objects" of the self-exam would seem to be an important part of Valentine's Day and of your health for years to come. So if you detect something suspicious during the exam, you may have received and given to your significant other the greatest gift of all… the opportunity to be treated and lead a long and healthy life.
Of the millions of viewers who will see the Valentine's Day PSAs, some are likely to have testicular cancer and not be aware of it. So we hope you will take a moment to read Dr. Adam Feldman's essay on how to conduct a self-exam and why it is so important. Dr. Feldman is a Urologic Oncologic surgeon at Massachusetts General Hospital in Boston.
Wishing you good health and a Happy Valentine's Day!
The CBS Cares Team
Dr. Adam S. Feldman Essay
With major advances in diagnosis and effective timely treatment, testicular cancer has become one of the most curable cancers. Nevertheless, it can be an aggressive form of cancer which must be taken seriously with prompt evaluation and management. Increased public awareness and education about the disease are incredibly important, especially since delays in diagnosis are not uncommon due to either a sense of embarrassment or lack of regular testicular self-exams.
Testicular cancer is the most common type of solid cancer in men who are 15 to 35 years old and is the second most common in men aged 35-40.This disease can occur at any age with peak incidences occurring not only in early adulthood (20-40 years), but also in late adulthood (over 60 years) and infancy/childhood (0-10 years).
For unclear reasons, the incidence of testicular cancer has been rising since the early 1900s. In 2010 in the United States, approximately 8,500 men were diagnosed with testicular cancer and 350 men died of the disease. The lifetime risk of developing testicular cancer has been estimated at 1 in 500 men, or 0.2% .
Testicular cancer occurs approximately three to four times more often in white men than in African American men, however, it has become evident that the incidence in African American men has been rising in recent years. Although it is unclear if there is a true genetic predisposition, a family history of testicular cancer is a risk factor for the development of the disease. In addition to family history, other risk factors include a personal history of undescended testicle, infertility, and HIV infection.
The majority of testicular cancers present as a painless lump or swelling in one testicle. However, 30 to 40% of patients will have a sensation of a dull ache in their lower abdomen or scrotum and approximately 10% of men will have acute testicular pain. Up to 20% of patients can present with signs of metastatic spread including unintended weight loss, persistent back or abdominal pain, breast enlargement or tenderness.
One of the most important factors in effective treatment of testicular cancer is early diagnosis and prompt treatment. For this reason routine testicular self-examination is incredibly important for all men to perform.
"How do I perform testicular self-exams?"
What I tell my patients is "examine your testicles once a month. Get to know them…understand what they feel like, and if anything changes come in as soon as possible to be evaluated."
The exam is best performed during or just after a shower or bath, when the scrotum is soft and the testicles are easiest to feel. It is best to do it in front of a mirror to look for swelling of the scrotum. It is common for one testicle to be a little larger than the other and the left testicle most often hangs slightly lower than the right.
Support the testicle with one hand and examine it with the other, rolling it between the thumb and the fingers. The testicle normally feels smooth and firm, similar to a hard-boiled egg without the shell. At the back of the testicle, you will feel a rope-like structure which is the epididymis. This is a normal tubular structure which collects and carries the sperm out of the testicle. Feel for any firm masses, lumps, or nodules. Lumps on the epididymis are typically not cancer, however, you should have any initial lumps that you feel evaluated by a doctor. Once you are familiar with what is "normal" for you, assess routinely for any change.
The good news about testicular cancer is that we have seen a dramatic improvement in survival over the past few decades, such that the mortality is now less than 5%. Much of this incredible increase in survival results from improved diagnostic testing, effective chemotherapy and advances in surgical technique.
Early diagnosis and prompt treatment remain critical! For this reason I urge all men to perform regular monthly self-testicular exams and if you feel anything abnormal, see your physician right away. There is no reason to be embarrassed or ashamed about something you might feel. Your role in identifying these tumors early is invaluable!
Adam Scott Feldman, MD, MPH - Biographical Sketch
Adam S. Feldman, MD, MPH, is a urologist at the Massachusetts General Hospital Department of Urology. He specializes in the treatment of cancer and related research. Dr. Feldman is a faculty member of the Department of Urology and a Urologic Oncologist at Massachusetts General Hospital. Dr. Feldman completed his residency in urology in 2006 and subsequently completed his fellowship in urologic oncology in June 2008. His clinical practice is focused on the surgical management of genitourinary cancer using both open and laparoscopic techniques. Dr. Feldman also is involved in clinical and translational research in cancers of the prostate, bladder, kidney and penis. He recently received a three year Young Investigator Award from the Prostate Cancer Foundation for his work in biomarker discovery and analysis in prostate cancer.