ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2018
Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records.
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 10 citations in OpenAlex.
- Cancer risk in patients with recurrent or persistent symptoms: a systematic review.The Lancet regional health. Europe · 2026Review
- Testicular cancer incidence and associations with prior epididymo-orchitis or urinary tract infections: a national cohort study in Sweden, 1964-2018.BMJ oncology · 2026Article
- Recognizing sinonasal cancer in primary care: a matched case-control study using electronic records.Family practice · 2022Article
- Recognising laryngeal cancer in primary care: a large case-control study using electronic records.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Article
- A Cross-Sectional Analysis of Testicular Cancer Symptom Recognition and Stage of Diagnosis.American journal of men's healthArticle
Corrections and comments
- Erratum issuedCorrections.2018
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTesticular cancer incidence has risen over the last two decades and is expected to continue to rise. There are no primary care studies on the clinical features of testicular cancer, with recent National Institute for Health and Care Excellence (NICE) guidance based solely upon clinical consensus.
aimTo identify clinical features of testicular cancer and to quantify their risk in primary care patients, with the aim of improving the selection of patients for investigation. DESIGN AND
settingA matched case-control study in males aged ≥17 years, using Clinical Practice Research Datalink records.
methodPutative clinical features of testicular cancer were identified and analysed using conditional logistic regression. Positive predictive values (PPVs) were calculated for those aged <50 years.
resultsIn all, 1398 cases were available, diagnosed between 2000 and 2012, with 4956 age-, sex-, and practice-matched controls. Nine features were independently associated with testicular cancer, the top three being testicular swelling (odds ratio [OR] 280, 95% confidence interval [CI] = 110 to 690), testicular lump (OR 270, 95% CI = 100 to 740), and scrotal swelling (OR 170, 95% CI = 35 to 800). The highest PPV for 17-49-year-olds was testicular lump, at 2.5% (95% CI = 1.1 to 5.6). Combining testicular lump with testicular swelling or testicular pain produced PPVs of 17% and 10%, respectively.
conclusionTesticular enlargement carries a risk of cancer of 2.5% - close to the current 3% threshold in UK referral guidance. Contrary to traditional teaching, painful testicular enlargement may signify cancer. Some initial hydrocele diagnoses appear to be wrong, with missed cancers, suggesting an ultrasound may be useful when a hydrocele diagnosis is uncertain. These results support the existing NICE guidelines, and help to characterise when an ultrasound should be considered in symptomatic men.
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