Testicular cancer: to screen or not to screen?

OBJECTIVES - To evaluate the evidence for and against routine testicular cancer screening by primary health care providers and patients (testicular self examination). SETTING - Low reported frequency of routine screening for testicular cancer attributed to poor knowledge of the disease and how to screen for it. METHODS - Literature based evaluation of the screening suitability of testicular cancer as a disease and palpation of the testis as the proposed screening test, and of the effectiveness of screening for testicular cancer. RESULTS - Testicular cancer is not a major public health problem. Its low prevalence makes routine screening cost ineffective. As a screening test for the disease, palpation has high sensitivity but its levels of specificity and positive predictive value are unacceptable. Palpation of the testes has not been shown to reduce mortality or morbidity. CONCLUSION - There is insufficient evidence to justify routine screening for testicular cancer by health care providers and patients. This lack of evidence may better explain the low reported levels of screening than can ignorance of the evidence available.