Screening for cancers with a good prognosis: The case of testicular germ cell cancer.
BACKGROUND
To determine, using testicular germ cell cancer screening as an example, whether screening can also be effective for cancers with a good prognosis.


METHODS
Based on the Dutch incidence, stage distribution, and survival and mortality data of testicular germ cell cancer, we developed a microsimulation model. This model simulates screening scenarios varying in screening age, interval, self-examination or screening by the general practitioner (GP), and screening of a defined high-risk group (cryptorchidism). For each scenario, the number of clinically and screen-detected cancers by stage, referrals, testicular germ cell cancer deaths, and life-years gained were projected.


RESULTS
Annual self-examination from age 20 to 30 years resulted in 767 cancers detected per 100,000 men followed over life-time, of which 123 (16%) by screening. In this scenario, 19.2 men died from the disease, 4.7 (20%) less than without screening, and 230 life-years were gained. Around 14,000 visits to the GP and 2080 visits to an urologist were required. This scenario resulted in the most favorable ratio between extra visits to the GP or urologist and deaths prevented (1418 and 116 respectively). Monthly screening, or screening until age 40 resulted in less favorable ratios. Self-examination by only the high-risk population prevented 1.0 death per 100,00 men in the general population. In all scenarios, 46-50 life-years were gained for each testicular germ cell cancer death prevented.


CONCLUSION
Despite the good prognosis, self-examination at young ages for testicular germ cell cancer could be considered.
['Heijnsdijk|Eveline A M|EAM|0000-0002-4890-6069', 'Supit|Steven J|SJ|', 'Looijenga|Leendert H J|LHJ|', 'de Koning|Harry J|HJ|0000-0003-4682-3646']
D000328:Adult D055088:Early Detection of Cancer D005500:Follow-Up Studies D006801:Humans D015994:Incidence D008297:Male D009373:Neoplasms, Germ Cell and Embryonal D009426:Netherlands D011379:Prognosis D012307:Risk Factors D015996:Survival Rate D013736:Testicular Neoplasms D055815:Young Adult
screening epidemiology risk model urological oncology