Health: Are you sitting on a problem?

While women are proactive about breast checks, men who may have testicular cancer are more reticent about seeking help.
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At 27 years old, the world road cycling champion Lance Armstrong looks the epitome of health. Firm, fit and muscular, he is an all-American boy by anyone's standards, and he came fifth in last week's world time trials in the Netherlands (Britain's top hope came 11th). It seems hard to believe that, just two years ago, Lance was undergoing emergency treatment for testicular cancer.

"I'm not sure what I thought at first - `I'll never race again', or, `I'm going to die'," he said, after going through the gruelling double ordeal of surgery and then chemotherapy.

Lance had at first ignored the symptoms and, by the time he sought medical advice, the cancer had spread to his lungs, stomach and brain. Now his message to all young men is: never leave it a day too long before you see the doctor.

Globally the disease is being seen more often, and in the UK the number of cases is growing - from 700 a year in the early Seventies to around 1,400 cases today.

No one really knows why, although one theory, from doctors at the Cancer Research Campaign, is that it may be caused by increased levels of the female hormone oestrogen in our environment.

The risk of men getting testicular cancer is still relatively low - much lower than that of a woman getting breast cancer. There are only 1,400 cases a year, compared with 30,000 breast cancer cases, and there is also one of the highest success rates for treatment - 90 per cent. Despite these encouraging statistics, men probably know more about breast cancer than about testicular cancer and, if they do spot a problem, are less likely to seek help than a woman is - which is foolish, as delay makes treatment more difficult.

David Brown, 36, who runs his own computer firm in Berkshire, ignored the lump in his right testicle for 17 months. "After the emotional shock, you kick into denial. I didn't tell anybody - I was living on my own and, when you are single, there is a high risk of hiding it. I thought there was something wrong but didn't want to admit it. I was afraid of what could be in front of me."

He left it so long that the cancer spread to his lower back. "I never had any pain to start with, but when it spread it was agony. By then, my testicle had grown to the size of a small grapefruit, although I didn't relate the two things."

That was in June 1992. He was rushed to hospital and the testicle was removed. At first he was given the all-clear. But five weeks later he was back in hospital with severe back pains. When his legs became paralysed the doctors realised that the cancer had spread.

"I was put on chemotherapy, with blocks of treatment for five days every month for six months followed by radiotherapy every day for two months. I lost my hair, which I coped with very badly. Although I knew I might die, my hair loss was a big thing. I would recommend anyone having chemotherapy to have their hair shaved off first. Then you don't have to go through watching it fall out on your pillow. "I was also sick 20 or 30 times a day, which was horrific, although anti-sickness tablets reduce the problem."

Losing a testicle is not as serious as it may seem. The other one will normally make enough sperm to compensate for the loss. Nor should a patient's sex life be affected.

It is possible to get an implant - many hospitals will offer this at the time of surgery, although David, who has now married his first wife for a second time, did not want an artificial testicle. "It doesn't interest me in the slightest. For a woman, if she had a mastectomy, it is fairly vital, but for a man the only time it is on view is when you are with your woman," he said.

Although fertility is not normally affected by chemotherapy, patients are offered the chance to store sperm, just in case. "But at the time, it is the last thing you want to do," says David. "It is almost surreal."

David is now infertile, although he does not know whether this was caused by the treatment, or had always been the case. "My sex life has also been highly affected because of my inability to move my lower limbs," he admits. His legs are still partially paralysed.

So why are men so reluctant to seek help? David says it was fear, rather than embarrassment, that stopped him. But he admits that most men don't even want to be seen in a doctor's waiting-room:

"Men don't normally go to the doctors until we are dying. It is quite difficult to get us there as 90 per cent of doctors' waiting-rooms are filled with women." Now his message, like Lance Armstrong's, is simple:

"If you have a swelling or a lump, then you have got to get to the doctor's right away. There is nothing else you can do."

A number of things can be done to treat testicular cancer, but, as David says, the main thing is to act fast if you are at all concerned. The first line of defence is to check your testicles regularly after a bath or shower. Any unusual swelling, lump or hardening should be checked with a doctor immediately. Do not delay, even for a week or two. If it is cancerous, the chances of successful treatment are high. Caught early, it may require only removal of the affected testicle. It is not a death sentence. In some cases, chemotherapy may be necessary, which usually involves temporary hair loss, but should not affect fertility.

Men who had an undescended testicle as a child are at a higher risk - five times more than other men - so they should be extra-vigilant. The risk is reduced to normal if the undescended testicle was corrected before the age of 10. Having a brother who develops testicular cancer increases your chances of getting the disease tenfold.

The risk is relatively low - one in 450 men will get the disease during their lifetime, compared to the one in 11 women who will develop breast cancer. If in doubt, you can ask to see a male doctor at your surgery.

Advice leaflets on testicular cancer are available from the Cancer Research Campaign (0171-224 1333); Imperial Cancer Research (0171-242 0200) and Bacup (0800 181199)

Testicular Cancer - The Facts

Common symptoms include a painless lump or swelling on one of the testicles; enlargement of a testicle, increase in testicular firmness, and aching in the lower stomach or groin

Symptoms of advanced testicular cancer include breast tenderness, back pain and shortness of breath

Peak incidence rates of 15-17 per 100,000 men are found in the 30-34 age group. It is the commonest cancer in men aged 20-34 years

Other possible risk factors include a lack of exercise and a sedentary lifestyle

No association has been found between testicular cancer and smoking or testicular temperature (wearing tight clothes, taking hot baths, etc)

Risk groups: white populations that already have high rates - with the exception of Japan.

Countries with Asian and black populations have lower rates, which have shifted very little

Higher rates of testicular cancer are associated with higher socio- economic status