The ignorance and fear of testicular cancer

Kevin Curtis knew for a couple of years he was at greater risk than most men. In an otherwise routine free-agent physical, a Minnesota Vikings doctor noticed something unusual. Nothing to be alarmed about at the time, just something for Curtis to monitor.

Curtis checked in with doctors periodically but went about his business as an emerging wide receiver. He signed with the Philadelphia Eagles in 2007 and had his greatest season: 77 receptions, 1,110 yards, six touchdowns.

His production slipped the next couple of years. Injuries dogged him. A sports hernia, a calf strain, left knee surgery. He played only 12 games in 2008 and 2009. The Eagles cut him.

Then came the truly bad news. That lump discovered way back in Minnesota had become something else.

"I don't think any man likes to hear the news," Curtis said. "The word cancer is scary enough. When part of the answer is removing the testicle, it was, like, boom."

Curtis was lucky to be in a profession that includes regular medical examinations. He bounced back from surgery in August and signed with the Miami Dolphins in December.

Testicular cancer frequently is detected by happenstance because men are too ignorant or too intimidated to bother paying mind.

There's a good chance testicular cancer will go undetected for a considerable time unless you're looking for it, or, more importantly, know what you're looking for.

"A lot of times when you do find out," Curtis said, "it's already too late."

April is testicular cancer awareness month. American Cancer Society data states about one in every 270 men will be diagnosed with testicular cancer, a highly treatable condition when detected early. About 8,480 new cases were diagnosed in 2010, while there were roughly 350 associated deaths.

By comparison, nearly 218,000 new cases of prostate cancer were diagnosed and over 32,000 deaths last year.

But testicular cancer still is the most common form of cancer found in men between 15 and 34 years old, according to the National Cancer Institute.

Among the notable testicular cancer survivors are champion bicyclist Lance Armstrong; ice skater Scott Hamilton; baseball players John Kruk, Mike Lowell and Scott Schoeneweis; Toronto Maple Leafs forward Phil Kessel; and former New York Jets punter Louie Aguiar.

Chicago Bears running back Brian Piccolo, immortalized in the film "Brian's Song," was 27 when he died in 1970 from a rare disease related to testicular cancer. Dan Turk, a 15-year offensive lineman and long snapper for five NFL teams, was 38 when died in 2000, just eight months after being diagnosed.

So often, testicular cancer reveals itself merely by accident. That makes awareness campaigns even more important.

Aguiar might not have realized the tumor without fortuitously striking himself while doing yard work in the 1998 offseason. Persistent pain sent him to the doctor two weeks later.

Hamilton's cancer wasn't detected until it had spread to his abdomen. Kruk's tumor was detected in part because pitcher Mitch Williams' pickoff attempt nailed him there 10 months earlier, causing an injury he and doctors kept a close eye on.

Jets executive vice president of business operations Matt Higgins did experience pain, but the hard-charging former press secretary for New York Mayor Rudy Giuliani after the Sept. 11 terrorist attacks didn't visit the urologist until his wife Michele forced him.

"If I hadn't been such an ignoramus, I definitely would have detected it," Higgins said. "Once you become familiar with your own body, you realize any change in your testicles is cause for concern. It can only be a few reasons.

"It's unfortunate that as guys we prefer to be blissfully ignorant sometimes, and that can be a fatal decision. If it hadn't hurt, I don't know if I'd be here today."

Broaching a subject as delicate as testicular cancer to young men and convincing them simply to consider self-examinations is critical to raising awareness. Canisius College has been successful with a campaign that captured their students' attention with insight and irreverence.

The Check Yo Nutz campaign began as a student project for a graduate communication course, but it became an effective campus cause now being handled by Canisius undergrads. It has been introduced to several high schools in the Buffalo area.

The program's name and mascot, ("Sammy the Squirrel knows the importance of checking his nutz"), can be disarming. But the cheeky approach is similar to other testicular cancer education programs such as the Orchid Cancer Appeal (British celebrities and sports stars deliver the slogan "Know your balls ... Check 'em out!"), Testicular Cancer Awareness Week ("Get a Grip!") and CarpeTestes.org.

Canisius communications professor and Check Yo Nutz faculty adviser Dr. Melissa Wanzer admitted being concerned initially when a student introduced the concept of Sammy the Squirrel. But mascots can be funny, and they're certainly popular when it comes to sports.

"These messages were made with young males in mind," Wanzer said. "We want materials they'll look at rather than be offended by.

"Thirty percent of advertising uses humor because it effectively calls attention to the message, but the other reason was because humor might make young males more receptive to it and to desensitize people and allow them to discuss this topic. We had to be creative to get people to pay attention."

As videos of student interviews prove at CheckYoNutz.org, young men essentially know nothing about testicular cancer compared to women's encyclopedic knowledge of breast cancer. Girls are educated about breast cancer at an early age. Focus groups at Canisius indicated testicular cancer detection simply isn't discussed at home -- or anywhere else.

"It's easy to think that if it happened to you, you would notice the change right away," Higgins said. "But I ask guys all the time: Do you examine your testicles? They'll say 'No,' or 'Not as much as I should.' And the more important question is 'Would you be able to detect a change if it was happening?' Most men, if they're being honest, say that they wouldn't."

Testicular tumors generally are painless, hard, inconsistently shaped and affect only one side. That makes any irregularity easy to compare to the other testicle. Risk factors include family history, an undescended testicle and race. White men are at five times the risk of black men and three times the risk of Asian or Native American men.

Detection is pretty easy -- if the young man knows that he's supposed to check.

Education materials at Canisius include postcards, brochures and shower hangers that residence life staffers report seeing on display in the dorms long after they're distributed.

Canisius research showed their male students were 29 percent more knowledgeable about testicular cancer symptoms, 22 percent more knowledgeable about how to conduct a self-exam, 37 percent more likely to perform a self-exam and 24 percent more likely to discuss testicular cancer with a friend or family member than they would've been before being exposed to the Check Yo Nutz campaign.

"Our males were significantly more informed about testicular cancer than the comparison group from another campus and were more likely to conduct self-exams," Wanzer said. "The effects of campaigns like this are very small. They might have a 10 percent increase to be considered decent. We had large changes, way bigger than average."

Treatment often requires the testicle be removed. Radiation therapy or chemotherapy also might be necessary, depending on how early the cancer is detected. Aguiar, for instance, underwent 15 radiation treatments before he returned to the Kansas City Chiefs, while Curtis has chosen repeat checkups over radiation.

Higgins does both. He had radiation treatment and visits the Memorial Sloan-Kettering Cancer Center every six months. To be safe, Higgins planned ahead before radiation so that Michele could be artificially inseminated. Their daughter, Collette, is 2 years old. Matthew Jr., conceived naturally, is 4.

Higgins, a big fan of the Check Yo Nutz campaign, is just as irreverent in his attitude. He often wears a dog tag -- a gift from Michele -- that reads: "Half the balls, twice the man."

"Having a complete set isn't what defines you as being a man," Higgins said. "It's a message of defiance. I'm not going to let this knock me down.

"There's no shame in having that. Part of what makes guys reluctant to come forward when there's something wrong is embarrassment. For me, it's a message that certainly your body doesn't define you."

Curtis admitted his only knowledge of testicular cancer at the time of his diagnosis was that Armstrong won the Tour de France after conquering it.

Curtis will be 32 years old in July and a free agent whenever the lockout ends. He lasted only two games with the Dolphins but latched on with the Chiefs for the playoffs and expects to play again in 2011.

But he's not going to take anything for granted.

"I don't mean to overdramatize this because I didn't have to deal with chemo or more surgeries," Curtis said. "It was a small battle, but it became a beautiful process to me.

"I embraced it. It's my deal. You just accept that it's yours. In a lot of ways, I'm grateful for it, I guess. The whole process takes you to some places I don't know I would have gone without it. News out of nowhere -- and I don't think I ever was in danger of dying -- but it made me really think about things, what matters most, perspective on how you're living your life.

"You just never know what's around the corner."