There is no good evidence that routine testicular self examination is of any benefit.4 5 6 Nor will there ever be: a study of adequate power would require millions of men, simply because testicular cancer is so rare.4 This fact is distorted by all the well meaning evangelism—few consumers of men’s health media would realise, for example, that the average general practitioner will see only one new case every 20 years.7
Another myth is that testicular cancer is a silent killer. In fact, nearly half of patients have testicular pain.8 And, though a painless testicular swelling is described as the typical presentation, this is often symptomatic—through causing a heaviness, a mass effect, or other symptoms.9 10 This may, understandably, prompt self examination, in which case the activity is typically misinterpreted as a life saving triumph. But this is simply a victory for common sense—for taking notice of symptoms and acting on them. It’s a world away from the notion of routine self examination in asymptomatic men, as advocated by the enthusiasts. The chances of discovering something significant from routine self examination of the ********* are minuscule—at least 50 000 men would need to examine themselves for 10 years to prevent one death.11
What will self examination elicit, though? Incidentalomas—because benign scrotal swellings such as varicoceles and epididymal cysts are relatively common.7 These will provoke anything from mild concern to incapacitating anxiety.4 And that anxiety can be infectious, worrying general practitioners into unnecessary ultrasound requests or referral, thereby lengthening the queue for patients who really do need further assessment.
It seems odd that there hasn’t been a more critical assessment of routine testicular self examination given that an analogous activity—routine breast self examination in women—has been discredited. There is no evidence that routine breast self examination is of benefit, but it is known to cause harm, through generating anxiety and unnecessary biopsies.12 Medical professionals have been slow to implement this evidence—perhaps because it seems counterintuitive, or because the Department of Health’s current policy of so called self awareness is difficult to understand or convey.
Or perhaps the real problem is the public’s confused and disbelieving reaction when the medical profession makes an about face. For example, when Michael Baum, professor emeritus of surgery and visiting professor of medical humanities at University College London, once explained the lack of evidence behind routine self examination of the breast to an audience of women in Miami, “About half the audience stormed out knocking over their chairs in their fury and one shouted out loudly, ‘We don’t need to listen to this crap.’” My own previous attempts to debate the merits of routine testicular self examination have been met, by men’s health groups and charities, with either disbelief or hostility—with the accusation, at one point, that I was “wishing cancer on men.”