ARA S TIRM A / ORIGINAL ARTICL E Gulhane T? p Derg 2011; 53: 17-25 © Gulhane Askeri T? p Akademisi 2011 Investigation of the frequency of testicular self examination performance in young adult males Ercan Gocgeldi (*), Necmettin Kocak (**), Serdar Ulus (**), Cenk Yeginer (**), Seref Basal (***) SUMMARY Testicular tumors are the second most frequently observed malignancy after leukemia in the age group of 20-35 in men. The rate of a 5-year survey is 99. 9% with early diagnosis. Awareness of the individuals and performing a testicular self examination by themselves are important in the early diagnosis.
Our aim in this cross-sectional study was to determine the performance frequency of testicular self examination and the factors affecting this among young adults. Of all the participants, 23. 3%, 6. 8% and 4. 7% declared that they had heard about testicular cancer and about testicular self examination, and that they had performed testicular self examination at least once in their life, respectively. The rates of hearing about and performing testicular self examination were found low in the present study, however these rates were higher among those who had heard of testicular cancer from population.
Well planned campaigns and educational organizations may be conducted in the country-wide in order to increase the awareness about testicular cancer and the frequency of testicular self examination. Key words: Soldier, testicular cancer, testicular self-examination, young adult man OZET Genc eriskin erkeklerde kendi kendine testis muayenesi yapma s? kl? g? n? n arast? r? lmas? Testis tumorleri 20-35 yas grubu erkeklerde losemiden sonra en s? k rastlanan 2. malignitedir. Erken tan? ile 5 y? ll? k yasam oran? %99. 9’dur. Bireylerin fark? ndal? g? ve kendi kendilerine testis muayenesi yapmalar? erken tan? icin onemlidir.
Bu kesitsel cal? smadaki amac? m? z, genc eriskin erkeklerde kendi kendisine testis muayenesi uygulama duzeyi ve buna etki eden faktorleri saptamakt? r. Kat? l? mc? lar? n %23. 3’u testis kanserini duyduklar? n? , %6. 8’i kendi kendisine testis muayenesini duyduklar? n? , %4. 7’si hayatlar? boyunca en az bir kez kendi kendisine testis muayenesi yapt? klar? n? belirtmislerdir. Cal? smam? z? n yap? ld? g? populasyonda kendi kendisine testis muayenesini duyma s? kl? g? ve kendi kendisine testis muayenesi yapma durumlar? dusuk bulunmustur, ancak bu oranlar testis kanserini populasyondan duyanlarda daha yuksek olarak bulunmustur.
Testis kanserinin fark? ndal? g? n? n ve kendi kendisine testis muayenesinin s? kl? g? n? n art? r? lmas? icin ulke genelinde iyi planlanm? s kampanyalar ve egitim organizasyonlar? duzenlenebilir. Anahtar kelimeler: Asker, testis kanseri, kendi kendine testis muayenesi, genc eriskin erkek * Department of Plan and Programming, Commandership of Health, Turkish Military Forces ** Department of Public Health, Gulhane Military Medical Faculty *** Department of Urology, Gulhane Military Medical Faculty This study was presented at the 12th National Congress of Public Health (Ankara, October 21-25, 2008) Reprint request: Dr.
Ercan Gocgeldi, Department of Plan and Programming, Commandership of Health, Turkish Military Forces, Bakanl? klar, Ankara, Turkey E-mail: drnkocak@gmail. com Date submitted: July 15, 2010 • Date accepted: November 01, 2010 Introduction Testicular cancer is one of the health problems, frequency of which continuously increases. Testicular tumors are the second most frequent malignancy after leukemia in males at the age group of 20-35 (1). The incidence of testicular cancer shows variations between countries, races and socio-economic classes. The rate is 6. 7% and 0. in Scandinavian countries and Japan, respectively. In the USA 2-3 new cases are reported per 100. 000 males per year (2). The risk of a development of testicular cancer in white males in the USA during the whole life is at a level of 0. 2%. The incidence in people of higher socio-economic classes is half of the lower socio-economic classes (2). Although the reason for testicular cancer is not known exactly, there is knowledge regarding that both congenital as well as some acquired factors are responsible in tumor development. The strongest relationship is with an “undescended testis”.
Approximately 7-10% of testicular cancers develop with cryptorchidism history. The cryptorchidism prevalence is 9. 2-30. 0% in premature births and 3. 55. 8% in mature births. Cryptorchidism frequency is 0. 8-1. 0% during the first age and remains unchanged with a ratio of 0. 7% until puberty (3). Five to 10% of testicular tumors occur on the opposite side, in the normal descended testis. The highest relative malignancy risk (1 of 20) is met in intra-abdominal testis. Placement of the cryptorchid testis into the scrotum (orchidopexy) reduces the malignancy potential of the cryptorchid testis (2).
The frequency of testicular cancer cases met on the right side is 52. 3%, on the left side 47. 7%, and the frequency of being bilateral is 2-3% (4). In general the patients consult the physician due to a painless single side bulge and mass in the scrotum. The growth of the testis in general develops slowly and a feeling of testicular pain is experienced. The common accepted opinion is that until the opposite 17 is approved, a determined asperity in the testis needs to be deemed as a malign tumor (3). Other symptoms are gynecomasty, pigmentation on the scrotum, and pain in the abdomen and the groin.
Scrotal pain develops at the late period of the tumor as a result of tunica albuginea or epididymis invasion (4). The time between the first discovery of the lesion in the testis and start of the definite treatment (orchidectomy) is 3-6 months in average. The time of the delay shows a correlation with the incidence of the metastasis. Approximately 10% of the patients are asymptomatic and can be detected upon trauma or by the sexual partner of the patient (3). Testis tumor often mimics epididymitis and epididymorchidis. Ten per cent of testis tumors mimics orchiepididymitis.
Their diagnosis can easily be made with ultrasound and anamnesis. Other diseases to be considered during the diagnosis are spermatocele, traumatic hematocele, granulomatous orchitis, varicocele and epidermoid cysts (3). Testicular cancer can be treated completely when they are detected in early stages. The chance for a 5-year life is 99. 9% with early diagnosis (5). Among the basic diagnostic methods, ultrasound, transillumination and computed tomography can be mentioned (1,3). Individuals’ awareness and their performing a testicular self examination (TSE) by themselves is important regarding an early diagnosis (3).
Routine testicular self examination (R-TSE) is an examination performed by the person himself at least once a month and regularly, which is made by using both hands, while holding the testis with one hand and examining the testis on masses during bathing or after bathing in front of a mirror (1,6). Along with the advantages that R-TSE is easy to learn and to apply, safe, non-invasive, economic, and does not need any special tools and devices, take time. When it is performed regularly each month, it provides that changes are detected early because the testis structure is known.
There are some studies examining testicular cancer and TSE performance frequencies. In these studies, TSE performance frequency varies according to the attributes of the group with which the study is realized. The frequencies of hearing about testicular cancer and TSE and performance of TSE in these studies are summarized in Table I. In the study performed by Ercan et. al. among 867 male university students between the ages of 18-30 years, it is determined that 8. 9% of the participants have heard about TSE, and 5. 1% perform TSE (6). In the study performed by Lechner et. l. among 274 students between the ages of 15-19 years, it is determi18 • March 2011 • Gulhane Med J ned that 3. 0% of the participants have heard about TSE and 2. 0% performed TSE (5). The TSE performance frequency of the participants of the study realized by Khadra et. al. among 202 persons of the ages of 18-50 years who consulted a polyclinic providing first stage health services is determined as 22. 0% (7). In the study performed by Moore et. al. among 203 people who are university students or graduates between the ages of 20-45 years, it is determined that 32. % of the participants have heard about TSE and 22. 0% performed TSE (8). In the study by Rudberg et. al. performed among university students in Sweden, it is determined that many of the students have not heard anything about TSE (9). In the study of Tichler et. al. among 717 soldiers and 200 military physicians in the Israeli army, 2. 0% of the soldiers and 73% of the physicians have stated that they have performed TSE (10). In the study of Vaz et. al. among 1364 adolescent males, 28. 0% of the participants stated that they had heard about testicular cancer (11).
In this study of Wardle et. al. among 7304 young male adults, it is stated that 13. 0% of the participants have performed TSE (12). In the study by Neef et. al. among 404 male college students, it is stated that 42. 0% of the participants heard about TSE, 22% performed TSE before (13). In the study by Cummings et. al. among 266 university students and male graduates, it is determined that 16. 0% of the participants have heard about TSE (14). In the study of Christine et. al. among 191 young adult males between the ages of 18-35 years, it is stated that 36. % of the participants have performed TSE (15). It is rather important that the male become more aware on testicular cancer, of which the frequency of incurrence has raised during the last years, they learn and apply TSE as an early diagnostic method. The aim of this study was to determine the testicular self examination performance frequency in young adult males. Material and Methods The universe of this study, planned in cross section type, was constituted by 5033 persons, who joined the Etimesgut Armoured Units Education Center Commandership in the recruitment period in November 2007.
There is no sample selection made for the study, it is targeted to reach the whole universe in a term of one week upon the start of the arrival of the soldiers to the unit. As some soldiers joined the unit except for working hours and that some rejected to participate in the study, not the whole of the universe could be reached, the study was performed with 3645 (72. 4%) persons. The data were collected by the researchers using the question form, developed by the researchers after a liGocgeldi et al. Table I.
Brief findings of studies regarding the performance of a testicular self examination Researchers Research type Age group Group attribute Hearing of Hearing (n) testicular of TSE cancer Ercan et. al. (6) Lechner et. al. (5) Khadra et. al. (7) Cross sectional Descriptive Descriptive 18-30 15-19 18-50 University students (867) High-school students (274) People consulting polyclinic providing a first stage health services (202) University students and graduates (203) High-school students (727) Male soldiers (717) Military physicians (200) Vaz et. al. (11) Wardle et. al. (12) Neef et. al. 13) Cummings et. al. (14) Descriptive Cross sectional Descriptive Descriptive Adolescent Young adult male (1364) 16486 students College students (404) University students and graduates (266) People living in industry complex (191) 42% 16% 28% 42. 9% 26. 0% 91. 0% 8. 9% 3. 0% 28% At least one performance of TSE in life 5. 1% 2. 0% 22% At least once a month performance of TSE Country Turkey Holland England Moore et. al. (8) Rudberg et. al. (9) Tichler et. al. (10) Descriptive Cross sectional Descriptive 20-45 15-21 90. 6% 11. 3% 32. 0% 5. 6% 22. 0% 11. 5% 2% 73% 5. 06% 1. 2% England Sweden Israel
USA 13% 22% 8% England USA USA Christine et. al. (15) Descriptive 18-35 36% USA terature hatch. On the question form, there are 7 questions regarding their socio-demographic attributes, 3 questions regarding the stories of the participants regarding cancer and testicular cancer, 10 questions regarding testicular self examination in order to determine their behavior and 15 questions regarding testicular cancer, symptoms and TSE were included into the knowledge test. The pre-test of the question form, prepared by the researchers was made with 20 soldiers of the Gulhane Military Medical Academy.
Support Troops Command, failures regarding the application and easiness to understand and observed failures regarding data entrance are amended. It was approved by the ethic commission. Groups of 20 persons of the soldiers who joined the Etimesgut Armoured Units Education Center Commandership in November 2007 were interviewed, the study and its aim were explained, if they should want to participate (those who orally accepted to) necessary information regarding some definitions in the inquiry (testis, undescended testis, testicular self examination) is provided orally such that Volume 53 • Issue 1 he participants can understand these and provided that they answer the questions under observation. The recruitment age in Turkey is 20 and those, who are not hindered join the Armed Forces in general at the age of 21 years. But only at a little part the recruitment age is later due to several reasons. Thus, in general male perform their military services at the age of 20-21. For that, the ages are grouped as 20-21, 2224, 25 years and above.
The occupational information of the participants is obtained as open end and afterwards a grouping regarding being or not-being related to healthcare is performed. The demographic distribution of the participants is grouped by the regionalization system of five of the Turkish Statistic Institute by respecting their provinces of birth. The data were analyzed by using the SPSS 10. 0 package statistic software. The descriptive statistics were given as frequencies and percent.
The TSE performance frequencies and completeness of some sociodemographic with descriptive attributes, the completeness of giving correct answers to each question of the knowledge test with the TSE performance freTesticular self examination • 19 quency, of which it was thought that they may have an effect on this, was compared with the chi-square, and the comparison of the average of the participants giving correct answers at the knowledge test according to their socio-demographic and descriptive attributes was compared with the Kruskal-Wallis and the Mann-Whitney U test. A p value of
