False Positive or False Negative: Which would you prefer?

Dr. Michael J Rovito

The following post is paraphrased from one of my recent guest lectures. It sparked
enormous debate and I was very pleased to see college students taking the initiative
to discuss their health among peers. Although the topic was testicular cancer and
testicular self-examination, I told the females in the class to parallel the discussion
to breast cancer and breast self-examination.

…and so the lecture/discussion began:

Would you rather feel a strange bump on your testicle, get anxious and worried, make
an appointment (still stressed out, mind you), go to your physician and have him/her
perform a manual examination on your testicles and have them tell you it’s nothing (a
false positive), or would you rather not even think about your testicular health and not
screen yourself, or get screened, for cancer? Let’s face it, statistically you have a very
slim chance of developing the disease so why would you even worry yourself over
something that could be absolutely nothing?

Perhaps for false positive cases a trip to the physician might cost you a co-pay and
your insurance company a couple hundred dollars for the 30 minute visit. But as long
as you do not have cancer, all is good. Right? On the other hand, what if you did not
perform regular testicular self-examinations or, if you did, you did not perform it
thoroughly? Perhaps you may have missed something. You would think you don’t have
cancer as you feel no lumps. Maybe even you refuse to realize you are vulnerable and
therefore have no reason to perform self-screening. But again, what if you actually do
have the disease but you believe that you don’t (false negative)?

So back to the original question, would you rather have some anxiety and worry about
whether or not you have cancer because you felt a lump on your testicle erroneously or
would you rather ignore or misperceive possible symptoms (lumps, heaviness in the
groin, etc) and believe you do not have testicular cancer when actually you do?

…after some initial reactions from the students, I continued:

Testicular is nicknamed the “hurricane cancer” for a reason. The tumor usually
doubles in size over the course of a few weeks. So the answer to your question should
be pretty clear. You would probably want to be a bit more involved with your bodily
health and understand what the warning signs are for the disease. If you look at Lance
Armstrong’s situation, all signs and symptoms were not paid proper homage. When he
was diagnosed with testicular cancer, it was already metastasized to his lungs and
brain. He was only given approximately a 40 to 50% chance of survival. If you catch
testicular cancer in its early stages, your chance of recovery is 99%. Do the math.

…again, more debate followed. At this point I was surprised at the passionate
exchange of ideas. Perhaps traditional barriers of modesty and
embarrassment to discuss such topics among not only other men, but females
as well (and vice versa), are being eroded. I concluded with the following:

Men need to understand their health is indeed at risk. Under no circumstances should
a man be uninformed of what those risks are and what he can do to limit them.
Although risks rise and fall with certain demographic variables, generally a man
should understand his body and how to achieve and maintain healthiness. Just because
you are a man does not give you a free pass to get out of unhealthy situations. In fact,
the traditional societal roles imposed onto men can indeed put them more at risk.
You’re a human. You are going to get sick at some point in your life. Some people more
than others. However, you have the power to help shape your health outcomes. So if
the question of whether you would prefer a false positive or false negative (in the case
of testicular cancer), you would probably rather be more safe than sorry.

…I left the discussion pleased. Maybe students are being more efficacious with
their health and well-being. That’s indeed something positive to hear amidst
the endless stream of bad news we experience every day from our cable news
channels, particularly what’s been going on in the Gulf of Mexico and
Afghanistan.