Screening of adolescents for testicular cancer-a nationwide retrospective cohort study

Testicular cancer is the most common malignancy in males aged 15-34 years, yet the value of screening asymptomatic adolescents remains unclear. We conducted a nationwide, population-based cohort study of 300 793 Israeli males aged 16-21 who underwent clinical testicular examinations between 2012 and 2021 before mandatory military service, generally lasting 3 years. Participants were followed for incident testicular cancer during their service. Screening involved inspection and palpation by general physicians, with referrals to ultrasound and urologists for suspicious findings. During 1 172 603 person-years of follow-up, 43 cases of testicular cancer were identified (incidence rate: 3.67 per 100 000 person-years). The sensitivity of screening was 66.7% and 40% at 6 and 12 months, respectively. Each cancer detected required screening 75 198 adolescents and included 176 ultrasound tests and 112 specialist consultations. Most cancers were diagnosed at stage I regardless of screening. The low sensitivity, high number needed to screen, frequent unnecessary evaluations, and low incidence of testicular cancer suggest that routine screening of asymptomatic adolescents is ineffective. These findings do not support routine testicular cancer screening in this population.