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breast cancer ribbonSo. October is Breast Cancer Awareness Month – the time of year when everything goes pink and moving stories of people’s struggles with the disease fill the glossies.

But aside from the human interest stories, the events and the fundraising, there’s also a very important health message behind BCAM.

Everybody knows detecting breast cancer early is vital. Treating the disease is generally much more successful if the disease is spotted early. That’s why the NHS spends millions of pounds a year on a breast screening programme that saves thousands of lives.

And encouraging women to go for screening is one of the central aims of BCAM, especially in the light of recent reports of low uptake in some parts of the country.

But what about self-examination? Is there anything women should be doing themselves, regularly, to help spot the disease?

For a large part of the 80s and early 90s, the message was clear: a monthly self-examination, using three fingers of one hand, moving in a circular motion, was the approach most cancer charities recommended.

But over the last 10 years the message has slowly changed, and the emphasis has shifted to ‘breast awareness’ rather than performing a regular monthly examination. This was based on research suggesting that rigorous monthly examination had no effect on death rates from breast cancer.

This approach has drawn criticism but the evidence suggests that its the best one. And this week the Canadian Cancer Society changed its advice to de-emphasise the monthly examinations too.

Here’s an excellent summary of the arguments for and against this move

And so its probably worth spelling out again, for posterity’s sake, what the Cancer Research UK advice to women is, and what ‘breast awareness’ means:

  • know what is normal for you
  • look at and feel your breasts
  • know what changes to look for
  • report any changes without delay
  • go for breast screening if you are 50 or over

Comments

Henry October 22, 2007

Hi Simon. Good spot. we do indeed encourage men to check their testicles regularly. Ed dug out some info on this, but we haven’t had a chance to knock it into something user-friendly. Bit snowed at the moment but here’s the official line, with refs. give me a shout if anything’s unclear…

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There is a clear association between delay in diagnosis and more advanced disease (1). Studies have shown that men who are diagnosed with advanced testicular cancer undergo more treatments and have a lower chance of survival. On the other hand, if the disease is caught early, it is relatively easy to cure. At least 9 in 10 men with testicular cancer currently survive their disease (2).

There have not been enough studies on testicular self-examination to determine if it can reduce the number of people dying from testicular cancer. But some experts feel that regular checks are an easy way for men to spot cancers early and there is a need for education about the early sign and symptoms of testicular cancer to reduce delay at presentation (3, 4).

In a similar way, studies have found that systematic breast self-examination does not reduce death rates from breast cancer. But since early detection improves survival rates, BSE has been abandoned for a policy of being breast aware, with an emphasis on knowing what is normal and reporting changes promptly (5). So for testicular cancer, men are not recommended to obsessively check themselves, but to be aware of the normal shape and feel of their testicles after puberty. It is only by knowing what is normal that any changes can be noticed and suspicious signs and symptoms acted on (6).

A study of over 300 men in Yorkshire found that the delay in presenting to GPs with testicular cancer symptoms had fallen from 5 weeks to 2 weeks since 1985. This indicates that health education initiatives aimed at increasing public awareness and self-examination are effective at reducing presentation delay (7).

1. Medical Research Council Working Party on Testicular Tumours. Prognostic factors in advanced non-seminomatous germ-cell testicular tumours: results of a multicentre study. Lancet, 1985. 1: p. 8-11.

2. Peate, I., Testicular cancer: the importance of effective health education. Br J Nurs, 1997. 6: p. 311-6.

3. Chapple, A., S. Ziebland, and A. McPherson, Qualitative study of men’s perceptions of why treatment delays occur in the UK for those with testicular cancer. Br J Gen Pract, 2004. 54: p. 25-32.

4. Austoker, J. Screening for ovarian, prostatic, and testicular cancers. BMJ 1994 Jul 30;309(6950):315-20.

5. Austoker, J., Be Breast Aware (leaflet). 1991: DH & NHS.

6. Hopcroft, K., C. Martin, and A. Moulds. What benefit testicular self-examination? Br J Gen Pract 2004 Mar;54(500):214; author reply 214-5.

7. Vasudev, B., J. Joffe, C. Cooke, F. Richards, and W. Jones. Delay in the diagnosis of testicular tumours – changes over the past 18 years. Br J Gen Pract, 2004. 54: p. 595-7.

Simon October 17, 2007

It makes sense, but it’s always going to be controversial when you change advice which people feel has saved their life. Is the advice similar for men with regard to testicular examination/awareness?