The CancerWeb Report, What's New In Cancer: July, 1996
Testicular Cancer

• Risk of a second testicular cancer in disease survivors - Germ cell testicular tumors represent one of the most successful demonstrations of the potential of chemotherapy, since the majority are cured, despite continuing increase in the incidence of the disease. However, the existence of increasing number of survivors of the disease, allows potential long-term effects of therapy and the occurrence of second cancers to be seen. Results of a study in Auckland and Christchurch, New Zealand, appeared in the July, 1996 issue of the Journal of Clinical Oncology. The medical records of 741 men, diagnosed with germ cell tumors of the testis between 1978 and 1994, showed a cumulative risk for developing a second germ cell testicular cancer of 5.2% over 15 years, a risk over 27 times greater than for other New Zealand men of the same age. Of the bilateral tumors, 31% were synchronous, a proportion much higher than in other published studies. (Colls, J Clin Oncol 14:2061, 1996)

  Editor's Comment: - The data would suggest that intensive follow- up of apparently cured cases of germ cell testicular cancer should be considered. The authors discussed the use of ultrasound as part of an annual examination, and this would appear to be well justified. It is impossible to determine whether the cause of this elevated incidence is somatic genetic predisposition, or a potential effect of chemotherapy. The authors state that there was a lower incidence of second tumors in the chemotherapy-treated group. Testicular cancer is a disease that is almost seven times more common in non-Hispanic white men than in black men in the US; Hispanics and Asians fall between these values. Overall mortality is only about 10% of the incidence figure.

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• Perinatal risk factors for testicular cancer - Testicular cancer rates peak in the third decade of life, but there are early-life factors such as undescended testes and occurrence in families, that suggest origins of the disease in infancy or even before birth. A statistical study carried out in the Uppsala region of Sweden, involving the participation of the Harvard School of Public Health in Boston, and published in the July 3, 1996 issue of the Journal of the National Cancer Institute, identified other early- life factors. Researchers found a more than doubled risk for all testicular cancer in those with neonatal jaundice (odds ratio 2.30) or low birth weight (odds ratio 2.59 for under 5.5 pounds or 2.5 kg), and significant increase for high birth weight (odds ratio 1.58 for over 8.8 pounds or 4 kg). When the types of testicular cancer were examined separately, high maternal socioeconomic status (odds ratio 2.54) as well as neonatal jaundice (odds ratio 3.96) and low birth weight (odds ratio 7.62) were associated with non-seminomas, whereas only high birth weight increased the risk (odds ratio 3.50) for seminomas. (Akre, J Natl Cancer Inst 88:883, 1996)