Recent trends in the incidence of testicular germ cell tumors in the United States

Abstract

SUMMARY Testicular germ cell tumors (TGCT), which comprise 98% of all testicular malignancies, are the most commonly occurring cancers among men between the ages of 15 and 44 years in the United States (U.S.). A prior report from our group found that while TGCT incidence among all U.S. men increased between 1973 and 2003, the rate of increase among black men was more pronounced starting in 1989–1993 than was the rate of increase among other men. In addition, TGCT incidence increased among Hispanic white men between 1992 and 2003. To determine whether these patterns have continued, in the current study we examined temporal trends in incidence through 2011. Between 1992 and 2011, 21,271 TGCTs (12,419 seminomas; 8,715 nonseminomas; 137 spermatocytic seminomas) were diagnosed among residents of the Surveillance, Epidemiology, and End Results (SEER) 13 registry areas. The incidence of TGCT was highest among non-Hispanic white men (6.97 per 100,000 man-years) followed by American Indian/Alaska Native (4.66), Hispanic white (4.11), Asian/Pacific Islander (1.95), and black (1.20) men. Non-Hispanic white men were more likely to present with smaller tumors (3.5 cm) and localized disease (72.6%) than were men of other races/ethnicities. Between 1992 and 2011, TGCT incidence increased significantly among Hispanic white (APC: 2.94, p<0.0001), black (APC: 1.67, p=0.03), non-Hispanic white (APC: 1.23, p<0.0001), and Asian/Pacific Islander (APC: 1.04, p=0.05) men. Incidence rates also increased, although not significantly, among American Indian/Alaska Native men (APC: 2.96, p=0.06). The increases were greater for nonseminoma than seminoma. In summary, while non-Hispanic white men in the U.S. continue to have the highest incidence of TGCT, they present at more favorable stages of disease and with smaller tumors than do other men. The increasing rates among non-white men, in conjunction with the larger proportion of non-localized stage disease, suggest an area where future research is warranted.

Genetic changes associated with testicular cancer susceptibility

“…Incidence of TGCT varies by geography and ethnic group: highest in Nordic populations (11.5/100,000), and lowest in African and Asian countries [2]. In the United States, there is a greater than fivefold incidence difference between non-Hispanic white men (6.2/100,000) and black men (1.2/100,000) [3]. However, the rate of TGCT globally among non-white men is rising, hypothesized to be secondary to changing environmental exposures; non-white men are more likely to present with more advanced disease due to diagnostic delay [3].…”

“…In the United States, there is a greater than fivefold incidence difference between non-Hispanic white men (6.2/100,000) and black men (1.2/100,000) [3]. However, the rate of TGCT globally among non-white men is rising, hypothesized to be secondary to changing environmental exposures; non-white men are more likely to present with more advanced disease due to diagnostic delay [3]. TGCT has been described as the model of a curable cancer, is generally exquisite sensitivity to chemotherapy, and has survival rates over 95% [1].…”

Testicular Germ Cell Tumors

“…It accounts for 1-2 % of testicular neoplasms [183,184]. Previously referred to as spermatocytic seminoma, the current terminology of ST has been recently adopted to avoid confusion with the much more common (classic) seminoma, which would carry prognostic and therapeutic implications.…”

Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach

“…1 Early stage (stage I and IIA/B) testicular seminoma has 5-year overall and disease-specific survival rates that exceed 90% and 95%, respectively. [2][3][4][5][6][7][8][9] Published guidelines for testicular seminoma provide consistent treatment recommendations, but followup schedules vary.…”