Knowledge, attitude and practices of Saudi Men towards testicular cancer and testicular self-examination in The Western Region of Saudi Arabia

Maha Shangab 1 , Hossam Alnowahi 1 , Mohammed Talal Al-Nazzawi 1 , Aabed Alguraigari 1 and Abdulaziz Baazeem 2 . 1. Batterjee Medical College. 2. Urologist, Umm Al-Qura University. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5(2), 1-6 2 Early detection is becoming, the only way to improve outcomes in accordance with the current successful therapeutic algorithm.
Determinants of early detection and diagnosis of TC are two-fold, one: Knowledge and oncology awareness of the male population, especially the young sector, and two: Performance of regular monthly testicular self-examination (TSE) as one of the first signs of TC is often a lump or swelling in the testis [6].
Conflicting views are found in the literature about whether TSE should be encouraged to the public, as some suggest that the costs outweigh the benefits, both because of the relatively low incidence compared to other health concerns and because of the anxiety they feel such a focus would provoke [7]. In 1996, Best et al, conducted a study by providing information about TSE to 1,286 high school male students and compared them to a control group after 6 and 18 months. The comparison demonstrated that while the knowledge level increased significantly, the anxiety level did not [8].
Some medical associations, such as the American Urological Association recommend TSE for the early detection of TC [9]. The American cancer society (ACS) recommends that examining a man's testicles should be a part of general physical exam, as well as a cancer-related check-up. Regular TSE has not been adequately evaluated enough to establish that it indeed lowers the risk of TC mortality. Thus, the ACS does not recommend regular TSE for all men. Still, some recommend that all men examine their testicles monthly after puberty [10].
In Saudi Arabia, few studies have been conducted to assess level of awareness about TC and TSE, and as a result, no general recommendations nor acknowledged expert opinions in the country addressed the issue. Therefore, the present study was conducted to assess the knowledge level, attitudes and practices of the general population about TC and TSE inSaudi Arabia.

Methodology and Materials:-
This is a cross-sectional study, which was conducted during March, 2016, in 2 public venues (King Abdullah Sports City, and Red Sea Mall) in Jeddah, Saudi Arabia. A total of 1600 randomly selected male subjects were interviewed by Medical Students.
Males above 15 years were interviewed. Exclusion criteria included the inability to perform TSE (e.g. bilateral undescended testis, hand motility disorders, etc.), andmales with severe mental disability.

Data collecting tools:-
A questionnaire was utilized to help collect data. It consisted of three sections. The first covered subjects' demographic characteristics. The second addressed questions regarding knowledge ofTC, while thethird addressed participants' knowledge, attitude and practices of TSE.All completed forms were anonymous.
Statistical analysis:-Levels of knowledge were calculated as total scores by setting different code systems to positive questions (Disagree = 0, Do not know = 1, Agree = 2) and negative questions (Disagree = 2, Do not know = 1, Agree = 0) then by transforming the scores into percentages and classifying into weak (<50%), average (50-75%), and high (>75%). Statistical analysis was performed with Statistical Package for Social Sciences (SPSS version 22.0). P<0.001 was set as statistically significant in comparison.

Results:-
The demographic characteristics (Age, Marital Status, Education and Occupation) of the participants are shown in table 1. 3

Discussion:-
This represents the first study; in Saudi Arabia to examine the knowledge, levels of practice and attitude towards TC and TSE. Several other studies have been conducted, in other countries, involving public audience [11], medical students [12], hospital technicians [13] and residents [14,15]as subjects.
TC Knowledge:-Our study subjects have shown significantly low levels of knowledge towards TC, where 93% have a weak level of knowledge. For example, 38.19% believed that prior trauma to the testis is a risk factor and 52.56% and 19.6% 5 believed that redness and itchiness of the scrotum is a symptom of TC. This lack of knowledge can be explained by the educational level of the majority of the subjects where 90.38% are either undergraduates or high school graduates (P<0.001) The percentage of subjects who has heard of TC in the current study is much lower than sohwn in another study that was conducted among technicians working in hospitals, which showed 63.6% having heard about TC. Given the fact that such subjects work in the health care field, a degree of higher awareness level is to be expected [13]. Furthermore, a different questionnaire was used to assess TC-related knowledge in the two studies As for knowledge about the treatment and prevention of TC, a similar low level of knowledge was demonstrated. A significant percentage of subjects responded with "I don't know" to questions about likelihood of TC cure (49.75%) and prevention(44.9%).

TSE Knowledge, Practice and Attitude:-
The current study suggests a low level of knowledge about TSE among Saudi men, with 19.56% having heard about TSE, and only 11.38% having ever performed it. These results are in keeping with even lower TSE knowledge and practice levels which were previously reported among young European men and medical students [11,12] Among the 16.88% who were educated about TSE, 33.95% stated having received their education from a physician. These findings support the role of physicians in teaching TSE. Unfortunately physician's participation in patient TSE education has been variable in different reports. A study involving pediatric residents revealed a high prevalence of 40% who regularly engaged in teaching TSE to their patients [14]. However, an earlier study showed only 17.5% of physicians taught TSE to adolescent male patients on a routine basis [15]. Such an increase in prevalence of teaching is promising, but a similar study in our country is necessary to state a definite comparison.

Conclusion:-
The results of this study shows a great lack in knowledge level about TC. It also demonstrates how the lack of knowledge and awareness of TSE and poor spread of education are primary barriers to TSE. Given the excellent prognosis of TC when detected early, it would be advisable to direct attention towards public education programs. Furthermore, emphasis should be given to patient education regarding TC and TSE but healthcare professionals.