Testes Test

A self-exam for cancer

Each month millions of women check their breasts for suspicious lumps in an effort to detect cancer early. Now doctors are urging men to perform a monthly self-examination of their own, this one aimed at cancer of the testicle.

The disease, though rare, is occurring with greater frequency. In the past 40 years, the incidence of reported cases has almost doubled in the U.S. Today it affects about four of every 100,000 men annually; an estimated 4,000 new cases are diagnosed each year. Once found primarily in older men, it now is the most common form of cancer in men between the ages of 20 and 34, causing 9% of all male cancer deaths in that age group.

No one knows why testicular cancer is increasing--or indeed why it strikes. It appears most frequently among white middle-and upper-class men. Two groups run 40 times the normal risk of developing the disease: men with a testicle that failed to descend from the abdominal cavity into the scrotum, a lapse that normally occurs during development of the fetus; and men with a testicle that descended only after they were six years old. Preliminary studies suggest that undescended testicles may be more frequent in boys born to women who received the hormone diethylstilbestrol, or DES, during pregnancy. The hormone was widely prescribed in the 1940s and 1950s to help prevent miscarriage.

Researchers at the University of California at San Francisco are beginning a three-year study of 250 patients with the disease to explore the connection with DES as well as other possible influences, including race, social class, on-the-job exposure to chemicals, even the type of underwear favored. One theory holds that men who wear tight shorts run a greater risk of developing the disease.

Although testicular cancer used to be regularly fatal, it is now often curable. Treatment may involve surgery, radiation and/or a combination of drugs, most notably cisplatin, which was first used experimentally only a decade ago. Even in severe cases, more than half the patients are cured. When the disease is detected early, the cure rate is nearly 100%.

Regular self-examination, say physicians, is the best way to find the disease early. The exam should be performed after a warm bath or shower, when the scrotal skin is most relaxed. The telltale sign is a lump the size of a pea. Doctors caution that a lump does not necessarily mean cancer, but it should be reported promptly to a physician and checked.

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