ROUTINE SCREENING NOT RECCOMENDED FOR TESTICULAR CANCER

September 21, 2010 — There is no new evidence to support screening for testicular cancer, according to a report published in the September 21 issue of the Annals of Internal Medicine.

In 2004, the US Preventive Services Task Force (USPSTF) concluded that screening asymptomatic men for testicular cancer was unlikely to produce any additional benefits over clinical detection. Researchers from the Agency for Healthcare Research and Quality now report that there is no new evidence to support changing the existing guidelines.

Kenneth Lin, MD, and Ruta Sharangpani, MD, MPH, searched the literature for new evidence on the benefits and harms of screening for testicular cancer to assist the USPSTF in updating its 2004 recommendations. However, they were unable to find any new studies that met their inclusion criteria.

"In 2004, the USPSTF recommended against screening for testicular cancer because of its relative rarity, the lack of evidence showing the accuracy of clinical or self-examination, and highly favorable outcomes from treatment," write the authors. "Instead, the USPSTF encouraged clinicians to consider testicular cancer in their differential diagnosis for patients with testicular symptoms."

Current Evidence Does Not Support Screening

The authors note that 2008 statistics reveal that approximately 8,000 men in the United States were diagnosed with testicular cancer, and 380 died of it. The overall incidence of testicular cancer is 5.4 cases per 100,000 men, with the highest incidence in white males. However, the incidence for this disease has been gradually rising since 1975. During that same period, cure rates for testicular cancer have also dramatically risen, as previously reported by Medscape Medical News.

There are currently no recommendations for testicular cancer screening in the general population. The National Cancer Institute (NCI) notes that, on the basis of current evidence, "screening for testicular cancer would not result in an appreciable decrease in mortality, in part because therapy at each stage is so effective."

At the same time, the harm of screening might outweigh the benefit. The NCI also notes that "screening for testicular cancer would result in unnecessary diagnostic procedures with attendant morbidity."

Reaffirm Previous Recommendation

Last year the USPSTF decided to update the evidence on screening to reaffirm its previous recommendation. The task force requested that this update address 2 key questions:

* What are the benefits of screening asymptomatic men for testicular cancer?
* What are the harms of screening asymptomatic men for testicular cancer?

Drs. Lin and Sharangpani conducted a search of the English-language literature for studies on the benefits and harms of testicular cancer screening in asymptomatic men that were published from January 1, 2001 to November 11, 2009.

Of the 113 articles retrieved, none met the inclusion criteria. The most common reason for exclusion, they note, was that the studies were conducted in symptomatic populations. In 2004, the USPSTF was unable to identify any studies that showed a benefit of screening, and the same holds true now.

Similarly, previous reviews failed to identify any research that demonstrated harms from screening, including the psychological effects of false-positive results and cost and complications from unnecessary confirmatory testing. The authors reiterate that their review failed to disclose any new studies on screening harms in asymptomatic participants.

Cryptorchidism and a family history of testicular cancer are established risk factors for the disease, but researchers continue to search for new ones. The authors point to a study that found that among 1504 healthy volunteers, approximately 5% (n = 84) had testicular microlithiasis (J Urol. 2001;166:2061-2064.). At the 5-year follow-up, only 1 participant was diagnosed with a testicular germ-cell tumor, which was discovered by self-examination (J Urol. 2008;179:1420-1423).

"Although these studies do not directly address the benefits of screening, they serve as a reminder for primary care clinicians to consider testicular cancer as part of their differential diagnosis in patients with testicular or scrotal symptoms, Drs. Lin and Sharangpani write. "As the USPSTF stated in a previous recommendation statement, although the average primary care physician may see only 1 patient with testicular cancer over 20 to 25 years, 26% to 56% of patients with testicular cancer had an initially incorrect diagnosis of another testicular disorder."

The study was funded by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Ann Intern Med. 2010;153:396-399.