I’ve just watched an episode of this Channel 4 programme.
Who can forget Dr Chris Steele doing the ‘first’ (!) testicular check on TV.
And now we have had the Embarrassing Bodies, the Channel 4 programme, providing us with more of the same.
It’s very tempting to think that more ‘awareness’ is always good for us, and it’s also easy to conclude that therefore, these programmes are good for us.
I’d disagree. We know that the problem with testicular cancer is NOT men being unable to find lumps, but in delaying seeking help with they do. We could speculate why, but small qualitative studies make clear that many men are frightened. That’s why it’s important that it’s clear to men that most testicular lumps are not cancer; testicular cancer is very treatable; hence prompt attention is needed to any new lump. Proper ‘awareness’ should include fair information which gets facts over, not fear about a cancer that might not be detected without the ‘right’ self examination skill.
We know from other similar ‘awareness’ interventions that they can increase health inequalities. Broadly, the least unwell, or least at risk of being unwell, get more attention than sick people. These kind of campaigns don’t often deliver to the people they are potentially most able to help.
We also don’t know that teaching men to do testicular examinations, in a formal way, is helpful. It’s not good enough to assume that it must be – there is good evidence that teaching women breast self examination does not reduce deaths from breast cancer, and it does harm, through generating more benign biopsies.
The new feature on the Embarrassing Bodies website is a ‘self checker’. There is a video on breast examination recommending monthly breast checks, and telling you how to do it, another video saying “how important it is to self-check your vulva”. Then there is a urine test, when yellow urine is declared “darker than normal which could be a sign of dehydration” . There is also the PHQ-9 Pfizer-owned tickbox test which apparently will “provide you with an indication of your risk of suffering from depression” ; even though there is no evidence that this will be useful in normal risk people. The risk screening tool used to ‘evaluate your risk of chronic renal disease’ is based on data used in high risk individuals, and, if you say, like many women, that you’ve a history of anaemia, and don’t know your blood pressure or whether there’s protien or not in your urine, the result is “it’s important that you get yourself checked out by your GP”.
I think it’s a good idea for people to have good information about their health. But it’s unfair to put insufficiently explained tests, or tests of unproven effectiveness up on their website and expect the NHS to cope with the fallout.
The things to do to keep healthy have hardly changed in the last 20 years. Don’t smoke, don’t drink excessively, eat a variety of foods, mainly plants, keep to a reasonable weight, do some exercise you like, and I’d add, meet people and do things you enjoy. That doesn’t include healthy people being taught to do regular self examinations or online questionnaires.