The official advice on whether men should regularly check their testicles for signs of cancer is: no, don’t do it.
But ever since he discovered a lump at the age of 17, health policy researcher Michael Rovito has been on a one-man mission to change the minds of the medical establishment.
The lump turned out not to be a tumor, but the experience led Rovito to study in graduate school how best to communicate with men about the risks and signs of testicular cancer. He’s since published a series of papers arguing how and why doctors should tell their patients to check their testicles regularly. And he’s even started a nonprofit — the Men’s Health Initiative — to push his message.
Yet, Rovito, now 35 and an assistant professor at the University of Central Florida, has a formidable adversary in his path: the US Preventative Services Task Force, which advises the federal government on health issues.
For more than a decade, the USPTF has recommended against routine testicular cancer screening, either by self-inspection or clinical examination. The reason? There’s no proof it saves lives. “Screening lacks benefits,” task force chair Dr. Albert Siu, a geriatrician at the Mount Sinai Medical Center in New York, told STAT.
Because treatment is so effective, it’s not crucial to find testicular cancer right when it emerges. Accidental discovery when a lump is big enough to be obvious is often good enough, according to leading physician groups.
Without some gold rush of funding, it’s highly unlikely that clinical trials of the kind the USPTF wants to see will be run anytime soon. But Rovito argues that the benefits of self-exams extend to finding testicular problems other than cancer, and that regular screening should not cause men too much anxiety — an often-cited risk of the practice (although the harms haven’t been systematically studied).
“Let’s just think about this from a different perspective from quantitative numbers and mortality rates, please,” he said.
Rovito is also going on the offensive against the USPTF with a paper now under review that directly calls on the task force to change its stance on testicular screening from a “D” grade, the strongest recommendation against a practice, to an “I,” the rating for insufficient information.
Some experts already practice what Rovito is preaching.
Dr. Joseph Alukal, a urologist at New York University’s Langone Medical Center, said that he’s treated patients who tried to ignore a lump in their testicles. Some waited until the mass was grapefruit-sized to come in.
“What’s the harm,” he said, “in asking [men] to just say, ‘Look, there’s nothing wrong with checking yourself once in the shower a month. Here’s what you should be feeling for.’”
Alukal said he routinely disregards the USPTF’s recommendations and examines all of his patients for signs of testicular cancer; he also tells most of his patients to check themselves.
But critics say there are downsides, too.
“Why would we just do something if we don’t know there’s evidence for it?”
Elizabeth Platz, Johns Hopkins University
Dr. John Tipton, of the University of Oklahoma-Tulsa, said that family medicine doctors like himself typically only have a few minutes with each patient, and doing a testicular examination for each one would take precious time away from other services.
“Everything that you add on detracts from something important,” Tipton said.
And for such a rare and treatable disease — only about 9,000 American men will develop testicular cancer this year, and fewer than 400 will die from the disease — Elizabeth Platz, a cancer epidemiologist at Johns Hopkins University, questions whether encouraging screening is a good use of public health resources.
“Why would we just do something if we don’t know there’s evidence for it?” she said.
Platz said she remembers when breast self-exams were thought to help women detect tumors early and was encouraged even in college-aged women. Then, a randomized controlled trial came out showing no benefit on breast cancer mortality.
“Women got very upset about that,” she said. “The evidence changed, so the guideline changed.”
She said the same principle applies to testicular cancer. While it may seem intuitively smart to have men check themselves, the evidence remains elusive.
Still, Rovito thinks educating men about risks to their health is worthwhile.
He recalled a time in sixth grade when the girls in his class were pulled out to learn about menstruation. The boys “had to stay there and play tic-tac-toe,” he said, while the girls “went and learned about their bodies, which I’m kind of jealous about.”
When he discovered a lump on his testicle in high school, he didn’t know what to do. He waited for it to go away, but it didn’t. “I sat there for a couple months thinking, ‘Oh my god, I’m going to die.’”
When Rovito finally went to the doctor, it turned out he didn’t have cancer. Instead, the lump was an enlarged vein in the scrotum.
Rovito now wants other men to be spared the ignorance and fear he felt at the time.
“If I ever have a chance to educate other guys on not just testicular health but other issues, just to get them more comfortable with bringing up the issues,” he said, “then I’ll consider that a happy life for me.”