title: From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening.
abstract: In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a 'D' recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the 'D' grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a 'D' grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current 'D' grade for TCa screening (i.e. discourage the use of said service) should be changed to an 'I' statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value.
authors.affiliation: College of Health and Public Affairs, Department of Health Professions, University of Central Florida, 12805 Pegasus Drive, HPA1 Room 269, Orlando, FL 32828, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rovito
authors.affiliation: Mayes College of Healthcare Business and Policy, Department of Health Policy and Public Health, University of the Sciences in Philadelphia, 600 S 43rd St, Philadelphia, PA 19104, United States.
authors.forename: Janna
authors.initials: J
authors.lastname: Manjelievskaia
authors.affiliation: Department of Movement Arts, Health Promotion, and Leisure Studies, Bridgewater State University, Bridgewater, MA 02325, United States.
authors.forename: James E
authors.initials: JE
authors.lastname: Leone
authors.affiliation: Michigan Institute of Urology, 6900 Orchard Lake Rd. West Bloomfield, MI 48322, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lutz
authors.affiliation: Dept. of Urology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States.
authors.forename: Ajay
authors.initials: A
authors.lastname: Nangia
keywords: Early detection of cancer; Practice guidelines as topic; Self-examination; Testicular neoplasms