My partner recently discovered an abnormal pea-shaped, semi-solid lump in his testicle. Specializing in women’s health, I had not done many male genital exams up to this point, but I knew when he asked me to palpate it that it was abnormal enough to warrant a next-day appointment with his GP. A subsequent ultrasound was performed and we were called into the urologist office two days later. We were informed his testicle was filled with cancer and they were removing it in three days. What a stomach-churning, terrifying moment to experience! It is now two months post-surgery and although his blood work continues to befuddle the doctor, three oncologists have consulted and are fairly certain he remains cancer-free. He is only 40 and on the tail-end of the typical age-group to get testicular cancer (20 – 35 years of age), plus, he’s far too young, healthy and vibrant (in my mind) to be diagnosed with cancer at all. It truly can happen to anybody.
In light of his journey, cancer screening is suddenly much higher on my radar and I want to share Canada’s current guidelines to encourage early detection and higher cancer survival rates.
The World Health Organization lists a number of well-known and researched-verified things you can do to reduce your cancer risk: avoiding smoking, be physically active, maintain a healthy weight, eat a diet high in vegetables and fruit, reduce alcohol overuse, take measures to prevent infectious diseases like hepatitis, and reduce exposure to environmental pollution, occupational carcinogens, and radiation.
Aside from the above, early detection of cancer through various screening methods can reduce morbidity and mortality rates. Here are some guidelines for the following cancers:
- Those with a very high risk of skin cancer should be screened yearly
- Those with a high risk of skin cancer should be counselled about skin self-examination
- For those with no increased risk of skin cancer routine self-examination and routine total-body skin examination by health care providers is not recommended
- To clarify the definitions of very high risk vs. high risk vs. no increased risk, please see the Cancer Care’s Screening for Skin Cancer
- The Canadian Cancer Society recommends that men and women age 50 and over have a stool test (fecal occult blood test) at least every 2 years. Follow-up may include a sigmoidoscopy, colonoscopy or barium enema if required. For those at increased colorectal cancer (ie. family history), a colonoscopy may be advised
This one isn’t cut and dry. The Canadian Task Force on Preventive Health Care issued updated guidelines in 2011 to reflect research which was suggesting the cost and harm of false-positive tests, overdiagnosis, and overtreatment was outweighing the benefits of more rigorous screening as stated in the previous screening guidelines (2001). Their new key recommendations:
- No routine mammography for women aged 40 – 49 (unless at higher risk); I personally recommend women do thermography in this age group
- Routine screening with mammography every two to three years for women aged 50 – 69 (previous guidelines dictated every two years)
- Routine screening with mammography every two to three years for women aged 70-74
- No screening of average-risk women using MRI
- No routine clinical breast exams done by health care providers or breast self-exams to screen for breast cancer (yes, you read that right!)
The following guidelines are from the Canadian Task Force on Preventive Health Care and are endorsed by the College of Family Physicians of Canada. From their website: “The recommendations are presented for screening asymptomatic women who are or have been sexually active. They do not apply to women with symptoms of cervical cancer, previous abnormal screening results (until they have been cleared to resume normal screening), those who do not have a cervix (due to hysterectomy), or who are immunosuppressed.”
- For women 20 years of age and younger they recommend not routinely screening for cervical cancer
- For women aged 20 to 24 they recommend not routinely screening for cervical cancer
- For women aged 25 to 29 they recommend routine screening for cervical cancer every 3 years
- For women aged 30 to 69 they recommend routine screening for cervical cancer every 3 years
- For women aged 70 and over who have been adequately screened (ie. 3 successive negative Pap tests in the last 10 years), they recommend that routine screening may cease. For women aged ≥70 who have not been adequately screened they recommend continued screening until 3 negative test results have been obtained
The Canadian Cancer Society put out a humorous video to offset some of the discomfort males feel about this topic. Share this liberally with all the men in your life. Unfortunately, as my partner and I were going through his cancer journey, I heard too many stories of males who had noticed a testicular lump but, from fear or embarrassment, they avoiding telling their doctor which led to higher complications.
There are no current screening guidelines in Canada for testicular cancer but there are a few important things males should know:
- Risk is increased with age (specifically between 15 – 40 years), an undescended testicle, or abnormal development of the testicle, and a brother or father who has been diagnosed with testicular cancer
- Males should know how their scrotum looks and feels (skin texture, size, shape) and should report any abnormal changes to their health care provider; these changes may include a lump in the testicle, a painful testicle, or sensations such as heaviness, dragging, or dull ache in the lower abdomen or scrotum
- An excellent summary can be found on the Peel Public Health’s website
- Guidelines were updated in 2013 by Prostate Cancer Canada to recommend that men in their 40s receive their first blood test called PSA (prostate specific antigen) to get a “baseline” of their normal that future PSA tests can be compared against
- Men at higher risk (family history of prostate or breast cancer, obesity, or men of African or Caribbean descent) should discuss with their health care provider getting a PSA test done in their 30s
- Many health care groups such as the American Cancer Society recognize that the PSA test is controversial and has its risks and limitations – men should be well informed prior to their decision to get a PSA test
- The Canadian Cancer Society discusses the use of the DRE (digital rectal exam) on their website but fails to give definitive details on what age this testing should be commenced in males
By updating yourself on Canada’s guidelines, I hope this clarifies the “when” and “what” in regards to cancer screening.