Risk factors for testicular germ cell tumors (TGCT) have not been well identified; however, data suggest that risks of cancer in family members of men with TGCT is elevated. Using family history data from 738 cases and 904 controls enrolled in the U.S. Servicemen's Testicular Tumor Environmental and Endocrine Determinants (STEED) Study from 2002 to 2005, the risk of cancer in first-and second-degree family members of these men was examined. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusting for reference age of case or control, race/ethnicity of case or control, sex of family member and lineage (maternal vs. paternal). An increased risk of all cancer among first-degree relatives of cases compared to controls was observed (RR 5 1.17, 95% CI: 1.01-1.35). There were suggestions of differences in risk when stratifying all relatives by lineage. For maternal relatives, there was a statistically significant increased risk of all cancer (RR 5 1.16, 95% CI: 1.04-1.30), digestive tract (RR 5 1.52, 95% CI: 1.15-2.00) and male genital organ cancer (RR 5 1.70, 95% CI: 1.15-2.51); there was also a suggestion of increased risks of hematopoetic cancers, cancers in the female genital organs and nonmelanoma skin cancer. For paternal relatives, there was a statistically significant association only with decreased risk of lung cancer (RR 5 0.69, 95% CI: 0.51-0.94). Thus, this study suggests that there may be aggregation of cancer among families of men diagnosed with TGCT. Published 2008 Wiley-Liss, Inc. This article is a US Government work and, as such, is in the public domain in the United States of America.Key words: testicular cancer; family; aggregation Testicular germ cell tumors (TGCT) are the most common tumors among men in the U.S. aged 15-35 years, and the incidence of certain subtypes is still rising. 1 However, with the exception of cryptorchidism, which has been shown to increase risk substantially, other risk factors for TGCT have not been well identified, 2 although there is some evidence that a genetic predisposition to TGCT may exist. Several studies have shown that men with TGCT, compared to those without, are more likely to have a family member also affected with TGCT. Brothers of cases have been shown to have a 5-to 14-fold increase in risk of having TGCT, [3][4][5][6] and this elevated risk is particularly evident among twins. 7 Fathers of men with TGCT have also been shown to have elevated risk of having TGCT, although the increase in risk is not as high, ranging from 1.75 to 4.50. 3,4,6,[8][9][10] Other studies have indicated an elevated risk of other cancers among first-and second-degree family members, including a higher risk of breast cancer 8,9,11-14 and cancer in the female genital organs of mothers or sisters of TGCT cases. 9,11 Thus, it is reasonable to posit that there may be an increased risk of hormonally related cancers among family members of men with TGCT.There have been several studies on aggregation of cancer among families ide...