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Brief Evidence Update
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Systematic reviews of the evidence serve as the basis for U.S. Preventive Services Task Force (USPSTF) recommendations on clinical prevention topics. The USPSTF tailors the scope of the review to each specific topic. The USPSTF determined that a brief, focused evidence review was needed to assist in updating its 1996 recommendations on screening for testicular cancer.1
Joe Scattoloni of the RTI-UNC Evidence-based Practice Center (under contract to the Agency for Healthcare Research and Quality [AHRQ]) performed a targeted review of the literature published on this topic between 1994 and 2001.
We searched MEDLINE® for articles focusing on meta-analysis, systematic reviews, randomized controlled trials (RCTs), and controlled trials or well designed cohort or case control studies reporting demonstrable health outcomes (morbidity and/or mortality) in humans that were published in English between the years 1994 and 2001. The Cochrane Library and National Guideline ClearinghouseTM were also searched for pertinent articles or recommendations.
The search strategy employed for MEDLINE® combined the exploded MeSH® heading of Testicular Neoplasm with Germinoma (limited to male) and crossed the result with Mass Screening, yielding 19 articles. These articles were further limited to RCTs by the exploded headings—randomized controlled trial/single-blind method/double blind method/random allocation, for which no articles were identified. Limiting to reviews also identified no articles.
Key Questions and Results
Key Question 1: Does screening for testicular cancer lead to decreased morbidity and mortality from testicular cancer?
We found no studies that addressed morbidity or mortality benefits of screening for testicular cancer.
Key Question 2: Is there evidence of harms associated with screening for this disease?
We found no studies that addressed the harms associated with screening for testicular cancer.
Testicular cancer is an uncommon disease in those without predisposing risk factors. With current treatment regimens, outcomes are very favorable, with 5-year survival greater than 90%. Although prognosis may be better for individuals with less advanced disease, there has been no substantive research in the past 6 years to shed new light on the real benefits of screening for testicular cancer. One of the reviews indicated that there were more data available for predicting development of contralateral cancer by screening for cancer in situ.2, 3 The reviewer acknowledged a disagreement between the United States and Europe's health policies on this data; readers may form their own conclusions. No ongoing research was identified in this review.
Recommendations of Professional Organizations
The Canadian Task Force on Preventive Health Care recommendations can be accessed at http://www.ctfphc.org.
The American Academy of Family Physician's recommendations can be accessed at: http://www.aafp.org/afp/20010315/1101.html
The American Cancer Society recommendations can be accessed at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_testicular_cancer_be_prevented_41.asp?
This brief update and the updated recommendations of the USPSTF are published as separate documents and are available through the AHRQ Web site (http://www.uspreventiveservicestaskforce.org) and through the National Guideline Clearinghouse™ (http://www.guideline.gov).
Copyright and Electronic Dissemination
This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Requests for linking or to incorporate content in electronic resources should be sent via the USPSTF contact form.
Current as of February 2004
U.S. Preventive Services Task Force. Screening for Testicular Cancer: Brief Evidence Update. February 2004. http://www.uspreventiveservicestaskforce.org/3rduspstf/testicular/testiculup.htm