Family Practice Vol. 19, No. 3, 294-296
© Oxford University Press 2002
Pilot study of testicular cancer awareness and testicular self-examination in men attending two South London general practices
Department of General Practice and Primary Care, St George's Hospital Medical School, London SW17 ORE, UK.
Khadra A and Oakeshott P. Pilot study of testicular cancer awareness and testicular self-examination in men attending two South London general practices. Family Practice 2002; 19: 294–296.
Received 26 August 2001; Accepted 7 January 2002.
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Abstract |
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Background. Testicular cancer (TC) awareness and testicular self-examination (TSE) have never been evaluated adequately in UK general practice. TC has a 96% cure rate if detected early.
Objectives. Our aim was to estimate awareness of TC and practice of TSE in a general practice population.
Method. A cross-sectional questionnaire survey was carried out in 250 consecutive male attenders aged 18–50 years in two general practices, one inner city, and one suburban. After obtaining informed consent, male patients in the waiting room were asked to complete a brief confidential questionnaire about TC and TSE.
Results. The response rate was 81%. Mean age was 32 years (range 18–50). Seventy-five per cent of responders described themselves as white, 12% Asian, 6% black and 7% other ethnic groups. Ninety-one per cent were aware of TC but only 26% knew both the age group most affected (25–34 years) and that TC can be curable if detected early. Although 49% of responders had carried out TSE in the past year, only 22% were practising according to recommendations: feeling for lumps at least monthly. TSE was associated with age >35 years, white ethnicity, knowing someone with TC, having attended a Men's Health Clinic and having heard of the ‘Everyman’ TC awareness campaign.
Conclusion. Although awareness of TC in this GP population was reasonable, less than half were practising TSE. Further public health campaigns may be needed.
Keywords. Testicular cancer, testicular self-examination.
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Introduction |
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Testicular cancer (TC) is the most common cancer in men between the ages of 15 and 34 years, and the incidence is rising. One in 500 men will develop TC before the age of 50, and ~25% will die of the disease. However, the cure rate is >95% if detected early.1
More than 90% of men with TC present with scrotal symptoms. Therefore, periodic testicular self-examination (TSE) has been recommended for early detection of TC.1–4 Although there have been no trials to assess the efficacy of TSE, the case for men being aware of the existence of TC and that if they notice a lump in their testes they should consult a doctor appears overwhelming.1 Poor health education in some patients is thought to contribute to their undue delay before seeking medical advice.3
Studies from the USA2 and Europe3,4 suggest a low prevalence of TSE, but no studies have been based in general practice surgeries in the UK. The aims of this study were to investigate the level of awareness of TC and practice of TSE in male GP attenders aged 18–50 years, and to see if TSE was related to age, marital status, education, ethnicity, social class, knowing someone with TC, having attended a Men's Health Clinic and having heard of a TC awareness campaign, particularly the 1999 ‘Everyman’ campaign featuring Robbie Williams.
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Method |
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Two general practices, one inner city and one suburban, were used to recruit men into the study. In May 2000, confidential questionnaires were given out by AK to consecutive male patients between the ages of 18 and 50 years attending the GP surgeries over a period of 1 month. The study was explained to them, a patient leaflet given and verbal consent obtained. The subjects then completed the questionnaires while waiting to see their GP and dropped them in a box provided at reception. The number of men refusing to take part was recorded. The questionnaire had been piloted previously among medical students at St George's Hospital Medical School.5 The data were analysed using SPSS.
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Results |
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A total of 202 questionnaires were completed (response rate 81%, 202/250). Mean age was 32 years (range 18–50), with 67% (138/202) between the ages of 18 and 35. Fifty-one per cent were single. Thiry-two per cent had education up to GCSE level and 44% had university degrees. Seventy-five per cent of responders described themselves as white, 12% Asian, 6% black and 7% as other ethnic groups. Thirty-eight per cent were in social class 1 or 2, 45% in class 3 and 15% in class 4 or 5. Although 91% claimed to be aware of TC, only 26% knew both the age group most affected (25–34 years) and that TC can be curable if detected early. Sixteen per cent had known someone with TC. Only 28% had heard of a TC awareness campaign (8% had heard of the ‘Everyman’ campaign).
Forty-nine per cent of responders had carried out TSE in the past year, but only 22% did so according to recommendations, i.e. feeling for lumps on a monthly basis. Table 1
shows that TSE was associated with age >35 years, white ethnicity, having correct knowledge of TC, knowing someone with TC, having attended a Men's Health Clinic and having heard of a TC awareness campaign.
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TSE was suggested by the media to 56% of those who examined themselves and by a nurse or GP to only 16%. Forty-eight per cent of those carrying out TSE had received written instructions, and 10% had received a testicular examination by their GP. Only 3% had attended a Men's Health Clinic in the past. Of those 103 responders not carrying out TSE, 71% said they did not know what to do, 27% said they were too busy and 2% were afraid they might discover a lump. Eighty-five per cent (169/199) of the men were keen to find out more about TSE and 67% (136/202) would attend a Men's Health Clinic if one were set up in their GP's surgery.
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Discussion |
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This is the first UK study of TC awareness and TSE in male GP attenders. It found that knowledge of TC was reasonable, but TSE was only being practised according to recommendations by 22% of responders. TSE was associated with older age, white ethnicity, better knowledge and acquaintance of someone with TC, attending a Men's Health Clinic and awareness of a TC campaign.
The main limitation of the study was the small sample size. However, the ethnic distribution of responders was similar to that in the same area in the 1991 census. In addition, results were comparable with those of a recent study of TC awareness and TSE prevalence in a 1999 MORI poll.4 This examined a nationally representative sample of 936 men aged 
15 and found that 22% carried out regular TSE.
This study suggests that the prevalence of periodic TSE is low in this primary care-based population. Although numbers were small, our data suggest that Men's Health Clinics may be effective in getting the message across. Unfortunately, such clinics are only available in a limited number of surgeries. Public health campaigns may also encourage more men to carry out TSE.4 In addition, we suggest that young men attending GP surgeries for any reason might be offered opportunistic health education on TSE, perhaps accompanied by a patient leaflet.
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Acknowledgments |
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We are very grateful to Sally Kerry for statistical advice. The study was supported by grants from the Claire Wand Fund (BMA) and the Cancer Prevention Research Trust.
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References |
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1 Dearnaley DP, Huddart RA, Horwich A. Managing testicular cancer. Br Med J 2001; 322: 1583–1588.
2 Garnick MB. Testicular self-examination. N Engl J Med 1980; 302: 297.[Medline]
3 Thornhill J, Conroy R, Kelly D, Walsh A, Fennelly J, Fitzpatrick J. Public awareness of testicular cancer and the value of self examination. Br Med J 1986; 293: 480–481.
4 MORI poll. Awareness of Testicular and Prostate Cancer. Institute of Cancer Research, 1999.
5
Khadra A. General practice perspective on cancer services. Fam Pract 2001; 18: 463–464.
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