Today more than ever, patients, providers and researchers are working together to rethink the basis for early detection of cancer. Taking lessons learned from the cancer survivorship movement, we are appreciating that success isn’t only about improving survival rates, but how patients survive. In most cases, success in early detection means that a patient will survive with less intensive therapy that is more cost effective with less interruption to their quality of life.
As a long-term survivor of testicular cancer, and as a young adult cancer specialist, this evolution is apparent to me. Testicular cancer is rare across the general population and yet is the most common cancer of men in their 20s or 30s. With the success of modern chemotherapy, even those men with advanced, metastatic testicular cancer have a very high chance for cure.
For these reasons (low incidence and high cure rate), groups such as the U.S. Preventive Services Task Force have routinely recommended against teaching patients to perform testicular self-exams. Part of their rationale for discouraging self-exams is the reality that some men will find something of concern that then will lead to unnecessary and costly medical visits, imaging tests and blood work ― only to prove it is not cancer after all.
But, imagine you are that man with testicular cancer.
Your chance for cure may be high no matter how early it’s found, but finding it late, when it has spread beydond the testicle, means that to get to a cure you must receive chemotherapy and perhaps endure major surgery. That comes with great cost, financial and emotional.
An economic analysis published earlier this year considered a comparison of all of the expenses in working up men who turn out not to have testicular cancer with that of treating a single man who presents late, with testicular cancer that has spread. For the same cost of treating a single man with a late presentation, we could pay for 313 office visits for men with false alarms.
Even if some of those men without cancer have findings concerning enough to warrant more intense testing, we could pay for 180 visits with ultrasound, or 79 visits with repeated ultrasound and blood tests. In fact, for the cost of treating one advanced case, we could even pay for the complete treatment of three men who actually have testicular cancer at an early stage. And an early diagnosis costs three times less to manage than a late diagnosis; this doesn’t even account for the emotional and physical stress of receiving chemotherapy and/or surgery.
For these reasons, many now feel that testicular self-exam should be recommended, not discouraged, and serves as an example of the evolving thinking around early detection of cancer. Ultimately, at the Knight Cancer Institute, our goal is to improve upon early detection methods by better understanding the initial biological triggers of the disease. We believe it’s one of the most important unmet needs in cancer care today. With more sophisticated early detection tools, we won’t risk unnecessary treatments and procedures. But until those detection methods are a reality, we need to make wise use of the resources we have today to safeguard our health.
Brandon Hayes-Lattin, M.D. is a board certified oncologist with the Knight Cancer Institute specializing in blood cancers and stem cell transplants. He established and is the medical director of the Knight Cancer’s Adolescent and Young Adult Oncology Program. As a cancer survivor himself, Dr. Hayes-Lattin is in a unique position to empathize with and understand the needs the young patients he treats.