Selection of men for investigation of possible testicular cancer in primary care

Testicular cancer incidence has risen over the last two decades, with nearly 2300 new cases annually in the UK. This large case-control study using electronic records identifies clinical features of testicular cancer and to quantifies their risk in primary care patients. Over a 12 year period, 1398 cases of testicular cancer were identified, which were matched with 4956 controls. Nine features were independently associated with testicular cancer, the top three being testicular swelling, testicular lump and scrotal swelling. The highest positive predictive value (PPV) for 17-49 year-olds was testicular lump. Combining testicular lump with testicular swelling or testicular pain increased PPVs to 17% and 10% respectively. Until now there was no primary care study on the clinical features of testicular cancer, and recent NICE guidelines were based solely on clinical consensus. These results support the current NICE guidelines, but also add to the current evidence that combinations of specific symptoms may warrant urgent referral.

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