True screening

True screening would involve evaluating an entire asymptomatic population for testicular cancer. With the overall high curability and low incidence of this disease, it is debatable whether we should invest in screening programs for testicular cancer. The principal screening test for testicular cancer is palpation of the testis by an examiner [37]. The sensitivity, specificity, and positive predictive value of the testicular examination in asymptomatic individuals are unknown. False-negative and false-positive examinations because of epididymal and testicular changes from infections, trauma, and cysts are common even among urologists and would be significantly higher among other practitioners. Varicoceles and hydroceles, relatively common conditions, also would pose accuracy problems for screening physical examinations. Alternatively, scrotal sonography might be more accurate in general widespread screening, but the cost-effectiveness of this modality for this uncommon neoplasm is questionable [38].

Despite these concerns regarding testicular examination, the American Cancer Society and the National Cancer Institute [39,40] recommend that it be included as part of the periodic health examination of men. The Canadian Task Force and the US Preventive Services Task Force, however, recommend that screening examinations should be performed only on patients who have risk factors, such as those with a history of crypt-orchidism or testicular atrophy [37,41]. Aside from age, the only currently known main risk factors for testicular cancer include cryptorchidism, Caucasian race [42], prior testicular tumor, and family history. Screening of these risk groups may be beneficial, although the value has not been proved.

Because of the rarity of this disease and the inaccuracy of the screening test (scrotal examination by physician), routine screening examinations of the genitalia of all asymptomatic men would have a low yield and would not be cost effective. From the available information, general screening of the population is not indicated, but a testicular examination should be part of the male physical examination, and periodic screening for men with risk factors may be beneficial.

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