title: Delay in Diagnosis of Testicular Cancer; A Need for Awareness Programs.
abstract: OBJECTIVE
  To gain insight into patient and doctor delay in testicular cancer (TC) and factors associated with delay.
  
  
  METHODS
  Sixty of the 66 eligible men; median age 26 (range 17-45) years, diagnosed with TC at the University Medical Center Groningen completed a questionnaire on patients' delay: interval from symptom onset to first consultation with a general practitioner (GP) and doctors' delay: interval between GP and specialist visit.
  
  
  RESULTS
  Median patient reported delay was 30 (range 1-365) days. Patient delay and TC tumor stage were associated (p = .01). Lower educated men and men embarrassed about their scrotal change reported longer patient delay (r = -.25, r = .79 respectively). Age, marital status, TC awareness, warning signals, nor perceived limitations were associated with patient delay. Median patient reported time from GP to specialist (doctors' delay) was 7 (range 0-240) days. Referral time and disease stage were associated (p = .04). Six patients never reported a scrotal change. Of the 54 patients reporting a testicular change, 29 (54%) patients were initially 'misdiagnosed', leading to a median doctors' delay of 14 (1-240) days, which was longer (p< .001) than in the 25 (46%) patients whose GP suspected TC (median doctors' delay 1(0-7 days).
  
  
  CONCLUSIONS
  High variation in patients' and doctors' delay was found. Most important risk variables for longer patient delay were embarrassment and lower education. Most important risk variable in GP's was 'misdiagnosis'. TC awareness programs for men and physicians are required to decrease delay in the diagnosis of TC and improve disease free survival.
authors.affiliation: Department of Surgical Oncology, University of Groningen, University Medical Center, Groningen, the Netherlands.
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Öztürk
authors.affiliation: Department of Health Psychology, University of Groningen, University Medical Center, Groningen, the Netherlands.
authors.forename: Joke
authors.initials: J
authors.lastname: Fleer
authors.affiliation: Department of Surgical Oncology, University of Groningen, University Medical Center, Groningen, the Netherlands.
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.affiliation: Wenckebach Institute, University of Groningen, University Medical Center, Groningen, the Netherlands.
authors.forename: Josette E H M
authors.initials: JE
authors.lastname: Hoekstra-Weebers
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D013736:Testicular Neoplasms / Q000175:diagnosis*; D055815:Young Adult