Testicular Cancer Screening Update
April 28, 2011 The United States Preventive Services Task Force (USPSTF) recently published its updated guidelines on testicular cancer screening and offered a reaffirmation of their previous recommendations from 2004.
With regard to screening for testicular cancer in asymptomatic males, the USPSTF recommendation states that there is inadequate evidence to suggest that screening via either self-examination or clinician examination has a greater yield for detection of testicular cancer. Therefore, this organization recommends against routine screening, as there is no evidence that such screening offers any net benefit, given a low incidence of testicular cancer and excellent treatment outcomes for detected cases. Similarly, these recommendations have been endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Cancer Society.
Testicular cancer remains one of most rare forms of cancer in men worldwide, yet is the most common cancer in men ages 15 to 34 years. In the US, the annual incidence is estimated at 5.4 cases per 100,000 men. Most cases of testicular cancer continue to be discovered by young men “accidentally”, or by their sexual partners.
Potential harms associated with screening for testicular cancer include the notion of false-positive results, the creation of significant anxiety and worry in men, and potential unintended harms from diagnostic tests or procedures.
Making a statement to recommend against screening for testicular cancer has led to much debate and concern among clinicians, despite a lack of strong evidence to suggest otherwise. Some clinicians have interpreted this statement as discouragement of patients seeking medical attention for testicular or scrotal symptoms, yet this notion breaches the definition of routing screening, and is not part of the explicit recommendation.
Reference: U.S. Preventive Services Task Force. Screening for Testicular Cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Ann Intern Med 2011;154:483-6.
Half of adult males may have HPV
March 17, 2011 A recent study published in the March 1 online edition of the Lancet, found that half of adult males in the United States, Brazil, and Mexico may be infected with the human papillomavirus (HPV). HPV has been linked to cervical cancer and other tumors. The study, funded by the U.S. National Cancer Institute, found that having multiple female or male sex partners significantly increased the risk of HPV infection in males. It also pointed out that about 6 percent of men are newly infected with HPV16 each year.
HPV16 is the virus which causes several cancers in men and cervical cancer in women. In 2009, 32,000 cases of cancers in American men and women were attributable to HPV infection. HPV infection has been tied to cancers of the penis, vulva, anal canal, head and neck, cervix, vagina, oral cavity.
The study was comprised of 1,159 men in the United States, Mexico, and Brazil, who were HIV negative and reported no history of cancer, aged 18 to 70.The researchers found that men who had 50 or more female partners were at 2.4 times increased risk for cancer-causing HPV infection versus one with one or no partners.The risk for men who had at least three male anal sex partners was 2.6 times higher than men with no recent partners.
However, to this point HPV vaccination has been uncommon in males. The cost-benefit ratio of vaccinating men against HPV has not yet been established. It should be noted that as more diseases are prevented through vaccinating males,routine vaccination for both sexes should prove more cost effective.According to various sources, HPV infects over20 million people in the U.S.
These findings should help public health experts, healthcare providers, and key thought leaders determine the value of widespread HPV vaccination of males in the United States and countries around the world.Healthcare providers have been quoted as saying that vaccinating boys and men (as done in Europe and Australia) is an important next step. This would not only protect boys and men from the disease, but as carriers of HPV, vaccination would also protect girls and women.
Reference: The Lancet, Early Online Publication, 1 March 2011. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Prof Anna R Giuliano PhD, Ji-Hyun LeeDrPH, William Fulp MS, Prof Luisa L Villa PhD, Prof Eduardo Lazcano PhD, Mary R Papenfuss MS, Martha Abrahamsen MPH, Jorge Salmeron MD, Gabriella M Anic MSPH, Dana E Rollison PhD, Danelle Smith MS
Available on the World Wide Web at: http://annonc.oxfordjournals.org/content/early/2011/01/25/annonc.mdq695.full.pdf+html