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Painful lump biggest risk factor for testicular cancer, says study



GPs should urgently refer painful testicular lumps as they are highly suggestive of cancer, a study has advised.

Researchers found that testicular lumps with pain or swelling were strongly associated with cancer, adding that GPs should urgently refer these patients to a specialist.

The study, published in the BJGP, was carried out by researchers at the University of Exeter Medical School and looked at just under 1,400 patients diagnosed with testicular cancer who had visited their GP in the year before their diagnosis.

Just under 5,000 controls without a testicular cancer diagnosis were also included.

The researchers looked at different clinical features associated with testicular cancer and used modelling to determine which had the greatest predictive values for cancer.

They found that a testicular lump had the highest predictive value in men aged between 17 and 49, at 2.5%, which is just below the NICE threshold of 3% for referring a patient urgently for suspected cancer.

When they combined testicular lump with testicular swelling or testicular pain, the positive predictive value of these features rose to 17% and 10% respectively.

They said in the paper: ‘These results largely support the UK recommendations for investigation of possible testicular cancer, though they provide additional information as to which symptoms or symptom combinations warrant ultrasound.

‘They also identify possible sources of delay in cancer diagnosis, such as mistakenly diagnosing a hydrocele, or considering a painful testicular mass to be low risk.’

Dr Elizabeth Shephard, study author and research fellow at the University of Exeter Medical School, said: ‘We know early and accurate diagnosis saves lives in cancer.

‘The findings of our study give greater clarity on which patients GPs should refer for further investigation for suspected testicular cancer in order to get the best outcome for patients.’

RCGP clinical lead for cancer Dr Richard Roope said: ‘Any testicular swelling should be checked out by the patient’s GP and these findings could assist GPs in better identifying symptoms of testicular cancer and knowing when to make an urgent referral so that men with the disease receive better outcomes.

‘Furthermore, it is encouraging to see this research, the first of its kind, focussing on the symptoms of testicular cancer reported in general practice, and we hope the findings will be considered by NICE in the development of their guidelines on the disease.’

NHS England announced plans in April to pilot ‘one-stop shop’ cancer diagnosis centres to speed up the diagnostic process for patients with non-specific symptoms suggestive of cancer.