Testicular Cancer and Testicular Self-Examination; Knowledge, Attitudes and Practice in Final Year Medical Students in Nigeria

  • Ugwumba, Fred O (Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital) ;
  • Ekwueme, Osa Eloka C (Department of Community Medicine, University of Nigeria Teaching Hospital) ;
  • Okoh, Agharighom D (Urology Unit, Department of Surgery, University of Nigeria Teaching Hospital)
  • 발행 : 2016.11.01


The testicular cancer (TCa) incidence is increasing in many countries, with age-standardized incidence rates up to 7.8/100,000 men in the Western world, although reductions in mortality and increasingly high cure rates are being witnessed at the same time. In Africa, where rates are lower, presentation is often late and morbidity and mortality high. Given this scenario, awareness of testicular cancer and practice of testicular self-examination among future first response doctors is very important. This study was conducted to determine knowledge and attitude to testicular cancer, and practice of testicular self-examination (TSE) among final (6th) year medical students. In addition, the effect of an intervention in the form of a single PowerPoint(R) lecture, lasting 40 minutes with image content on testicular cancer and testicular self examination was assessed. Pre and post intervention administration of a self-administered structured pre tested questionnaire was performed on 151 medical students, 101 of whom returned answers (response rate of 66.8%). In the TC domain, there was a high level of awareness of testicular cancer, but poor knowledge of the age group most affected, with significant improvement post intervention (p<0.001). Notable also was the poor awareness of the potential curability of TC, this also being improved following the intervention (p<0.001). A poor level of awareness and practice of testicular self-examination pre-intervention was found considering the nature of the study group..Respondents had surprisingly weak/poor responses to the question "How important to men's health is regular testicular self-examination?" Answers to the questions "Do you think it is worthwhile to examine your testis regularly?" and "Would you be interested in more information on testicular cancer and testicular self-examination?" were also suboptimal, but improved post intervention p<0.001, p<0.001 and p=0.037. Age, gender and marital status were without specific influence. In conclusion, this study showed poor levels of knowledge regarding epidemiology of TCa and its potential curability when detected early. There was also a poor awareness of, practice of, and poor attitudes to TSE. The significant improvement in these parameters post intervention indicates value in educational intervention. We recommend inclusion of TCa coverage and TSE teaching in the secondary school curriculum (targeting adolescents). Greater emphasis should also be given to testicular cancer in the curricula of medical schools and other training institutions for health care personnel.


  1. Akar SZ, Bebis H (2014). Evaluation of the effectiveness of testicular cancer and testicular self-examination training for patient care personnel: intervention study. Health Educ Res, 29, 966-76.
  2. Akhtari-Zavare M, Juni MH, Said SM, et al (2016). Result of randomized control trial to increase breast health awareness among young females in Malaysia. BMC Public Health, 16, 738.
  3. Bray F, Richiardi L, Ekbom A, et al (2006). Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality. Int J Cancer, 118, 3099-111.
  4. Cancer Society of South Africa (2016). Fact sheet on testicular cancer. Retrieved from
  5. Chalya PL, Simbila S, Rambau PF (2014). Ten-year experience with testicular cancer at a tertiary care hospital in a resourcelimited setting: a single centre experience in Tanzania. World J Surg Oncol, 12, 356.
  6. Evans REC, Steptoe A, Wardle J (2006). Testicular self examination: change in rates of practice in European university students, from 13 countries, over a 10-year period. J Mens Health Gend, 3, 368-72.
  7. Foster PW, Ritchie AW, Jones DJ (2006). Prospective analysis of scrotal pathology referrals - are referrals appropriate and accurate? Ann R Coll Surg Engl, 88, 363-6.
  8. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  9. Kuzgunbay B, Yaycioglu O, Soyupak B, et al (2013). Public awareness of testicular cancer and self-examination in Turkey: a multicenter study of turkish urooncology society. Urol Oncol, 3, 386-91.
  10. McMaster J, Pitts M, Wilson P (1994). The practice of testicular self-examination: a comparative study of British and Zimbabwean undergraduates. Cent Afr J Med, 40, 154-8.
  11. McCullagh J, Lewis G, Warlow C (2005). Promoting awareness and practice of testicular self-examination. Nurs Stand, 19, 41-9.
  12. Muliira JK, Nalwanga PB, Muliira RS, et al (2012). Knowledge, perceived risk and barriers to testicular selfexamination among male university students in Uganda. J Mens Health, 9, 36-44.
  13. Peltzer K, Pengpid S (2015). Knowledge, Attitudes and Practice of Testicular Self- examination among Male University Students from Bangladesh, Madagascar, Singapore, South Africa and Turkey. Asian Pac J Cancer Prev, 16, 4741-3.
  14. Rosen A, Jayram G, Drazer M (2011). Global trends in testicular cancer incidence and mortality. Eur Urol, 60, 374-9.
  15. Ramim T, Mousavi SQ, Rosatmnia L (2014). Student knowledge of testicular cancer and selfexamination in a medical sciences university in Iran. Basic Clin Cancer Res, 6, 1-5.
  16. Smith TJ, Davidson NE, Schapira DV (1999). American Society of Clinical Oncology 1998 update of recommended breast cancer surveillance guidelines. J Clin Oncol, 17, 1080-2.
  17. Shallwani K, Ramji R, Ali TS (2010). Self examination for breast and testicular cancers: a community-based intervention study. Asian Pac J Cancer Prev, 11, 383-6.
  18. Shanmugalingam T, Soultati A, Chowdhury S (2013). Global incidence and outcome of testicular cancer. Clin Epidemiol, 17, 417-27.
  19. Ugboma HA, Aburoma HL (2011). Public awareness of testicular cancer and testicular self-examination in academic environments: a lost opportunity. Clinics (Sao Paulo), 66, 1125-8.
  20. Ugurlu Z, Akkuzu G, Karahan A (2011). Testicular cancer awareness and testicular self-examination among university students. Asian Pac J Cancer Prev, 12, 695-8.
  21. Ugwumba FO, Aghaji AE (2010). Testicular cancer: Management challenges in an African developing country. S Afr Med J, 100, 452-5.
  22. Wardle J, Steptoe A, Burckhardt R (1994). Testicular selfexamination: attitudes and practices among young men in Europe. Prev Med, 23, 206-10.