UroToday - Regular testicular self-examination (TSE) is frequently promoted within testicular cancer (TC) public education materials as a means to detect cancer early. As yet there is no evidence demonstrating the clinical benefit of TSE practise and in an era of evidence-based medicine this has led to criticism over its promotion. While it is generally agreed that detecting cancer earlier would mean less intensive treatment, opponents of TC and TSE public education have argued that there is a danger of creating unnecessary anxiety about a rare disease for which treatment is so successful that even in late stage cure rates are in excess of 90%.

No randomised trial has been conducted that has evaluated the efficacy of TSE nor is there likely to be because the rarity of TC would make it prohibitively expensive. This lack of evidence has led to ambivalence over the policy of recommending TSE. In the US for example, TSE is not endorsed by the US Preventative Task Force but procedural instructions are given by the American Cancer Society, and to follow these is framed as a personal choice; a confusing situation for men who want to know what is best for their health.

The views of the public have been largely ignored in the 'TSE' debate, which has rumbled on for 20 years. Health professionals have been clear about their opinions both for and against TC and TSE education, but we cannot be sure that the public shares these. Describing the views of lay individuals may therefore enrich the debate, particularly if the views of those likely to have a specific interest in the issue (by virtue of their age, previous illness experience, parental role, or occupation) are considered.

We chose a qualitative methodology because so little is known about public attitudes towards TC and TSE. In-depth one-to-one interviews enabled us to explore attitudes towards TC/TSE education without the need for a priori information. The participants identified a range of harms and benefits that make a good starting point for generating knowledge within this area. Although the Framework approach is a well-established method of qualitative analysis, the limitation of a qualitative enquiry is that it cannot establish the validity of findings using traditional statistical methods with which empirical scientists are familiar. Nor can results be generalised to the population as a whole. However qualitative results do enable us to gain an impression of the diversity of views that exist among interested sectors of the public and to contrast these with the views commonly expressed by clinicians.

The most interesting finding from this study was that participants only identified anxiety as a potentially harmful consequence of exposure to TC education when prompted, and even then participants downplayed it as a minority response that could be easily managed. Anxiety was not seen as a reason not to educate men about TC and its importance may be exaggerated in the medical and public health literature. However, despite unanimous enthusiasm for promoting TC education, there was more mixed support for the inclusion of information about TSE, in line with the contrasting views of professionals. Some participants felt that given the rare potential for TC symptoms to be identified by men themselves, TSE should be promoted. Others felt that the obviousness of symptoms eradicated the need to promote TSE, because men would not fail to notice lumps or other abnormalities. The importance of how men react to symptoms and their attitudes towards help-seeking was considered by some to be of more relevance to improving early diagnosis, and TC education was seen to be a potential pathway towards increasing men's knowledge about the value of early detection and reducing barriers to help-seeking.

Ruth E.C. Evans, et al. as part of Beyond the Abstract on UroToday. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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