The USPSTF Recommends Against Testicular Exams, But Dr. Michael Rovito Doesn’t Agree.
Shortly after I interviewed Dr. Charles Modlin of the Cleveland Clinic last fall, a urologist tweeted to me, saying the following:
I assumed USPSTF was ‘United States Postal Service: The Fallen’ (an elite squadron of mail carriers who commemorate their brethren who could not brave the rain, snow, sleet, and hail). However, I was wrong. It’s actually the United States Preventive Services Task Force, who make rulings on different preventive measures that doctors should or should not recommend.
Over this past summer, I saw an article by Dr. Michael Rovito, an Assistant Professor of Health Sciences at the University of Central Florida and a certified health education specialist, who wished to change the USPSTF testicular cancer self-exam “D” ruling. While this does affect an area below the D, a “D” ruling means “don’t do it; it’s more harmful than helpful”).
After learning that he specializes in testicular self-examination, testicular cancer, male health behavioral change, and more, I reached out to him to learn more about his work and how he would change the ruling.
We first discussed the background of the original self exam ruling.
Every few years, experts in the field come together to review current evidence and make a decision. Back in the 1990’s, they made a decision to rule it as a “C” (“make your own judgement”). When it came back up for review in 2008, they looked specifically at the impact on testicular self-exam on decreasing mortality rates from testicular cancer.
However, there were no randomized control trials, so they used others. Kenneth Lin, MD, and Ruta Sharangpani, MD, MPH found three studies that look at semi-related matters, but ultimately were cherry picking the data. The validity was extremely low and didn’t even fit the criteria the USPSTF laid out.
Yet this ultimately led to the current ruling: a “D” rating for doctors doing testicular exams and teaching patients how to do self exams.
Dr. Rovito disagrees with the USPSTF ruling.
Paraphrasing the words of Director Nick Fury of S.H.I.E.L.D., he recognizes that the council has made a decision, but given that it’s a stupid-ass decision, he’s elected to ignore it. First and foremost, he believes the USPSTF is not even following its own guidelines. There is no sound evidence that performing or teaching about testicular causes more harm than good. When a testicular lump is detected, a balltrasound (a non invasive procedure) is ordered.
The only potential “harm” that the USPSTF cites is that over detecting can lead to anxiety. This is also pure speculation, as there are no studies confirming this. More to the point, Dr. Rovito said, “I would rather deal with that anxiety than deal with the anxiety of getting a stage three cancer diagnosis.”
In Dr. Rovito’s opinion, the testicular exam grade should be an “I”.
The “I” ruling stands for “not enough evidence to suggest one way or another.” Dr. Rovito does acknowledge there is limited beneficial evidence when comparing testicular exams to mortality rates. However, he still feels they are valuable. Furthermore, they can be used for other uses beyond the intended purpose of detecting cancer. These include issues such as hernia screenings or similar conditions.
The backstory on how the “D” ruling was developed also gives him pause. Since he feels that USPSTF haven’t even followed their own criteria for making sound judgements, testicular exams shouldn’t be recommended against.
Dr. Rovito recommends his patients do monthly self-exams. His attitude is to help men get to know their bodies to be the healthiest. To quote one of his colleagues, Jim Leone out of Bridgewater St. University, the “best way to be healthy is to know yourself. [A self exam] is one way to know yourself.”
To change the USPSTF ruling, there’s work that must happen first.
As with anything, it comes down to timing and talking to the right people. Dr. Rovito works closely with the Men’s Health Network, an advocacy group based in DC that lobbies on Capitol Hill. Recently, they wrote a letter to the Secretary of Health and Human Services and various members of Congress to ask that the Task Force be nudged in another direction.
The next review of the recommendation is due now, but as Dr. Rovito says, the USPSTF is “so intractable” and “hard to gain traction with.” He doesn’t quite understand why there is so much pushback, especially since testicular exams are free. After all, “guys are feeling themselves every ten minutes, least we can do it teach them to do it right!”
However, the USPSTF have made controversial rulings, as in the case of mammograms for breast cancer. In that case, Susan G. Komen, with a large number of voices and resources, came together to sway public opinion, and thus have been working to shift policy.
The same things need to come together on the men’s health side of things. Various men’s health organizations must come together to have these deep discussions with legislators and push past them surface level events for real change.
We all have the same endgame in mind and have to join together to protect our boys’ “boys.”
A self exam is how most cases of testicular cancer are detected early. Click the image for video directions or click here for a larger version
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