Screening for testicular cancer
- Kenneth W Lin, MD, MPH
Kenneth W Lin, MD, MPH
- Associate Professor of Family Medicine
- Georgetown University School of Medicine
Testicular cancer is the most common malignancy in males between the ages of 15 and 35 years . Although the incidence of testicular cancer has been increasing over the past three decades in the United States and worldwide [2-4], it still accounts for only about 1 percent of cancers in men, and its prognosis with treatment is generally excellent.
This topic will review issues related to screening for testicular cancer, including the lack of evidence that screening improves currently favorable outcomes for this disease. The epidemiology, clinical manifestations, and treatment for testicular cancer are discussed separately. (See "Epidemiology of and risk factors for testicular germ cell tumors" and "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors" and "Overview of the treatment of testicular germ cell tumors".)
In 2016, approximately 8700 men in the United States will receive a diagnosis of testicular cancer, and 380 men will die of it . The age-adjusted incidence and death rates of testicular cancer were 5.6 cases and 0.3 deaths per 100,000 men per year . Worldwide, the incidence and death rates for testicular cancer were similar: 4.6 cases and 0.3 deaths per 100,000 men per year . In the United States, more than 95 percent of men diagnosed with testicular cancer from 2001 to 2007 were alive five years later, with more than 200,000 testicular cancer survivors at the beginning of 2008 . These statistics reflect the excellent prognosis of testicular cancer with treatment, even in advanced stages. (See "Epidemiology of and risk factors for testicular germ cell tumors", section on 'Epidemiology'.)
Testicular cancer occurs most commonly in younger men, with almost half the cases occurring between ages 15 and 35 . Well-established risk factors for testicular cancer include a history of an undescended testis, a familial history of testicular cancer, or a history of contralateral testicular cancer . (See "Epidemiology of and risk factors for testicular germ cell tumors".)
Studies investigating the contribution of prenatal and later environmental exposures to testicular cancer risk have yielded inconsistent results . There is some suggestion that infertility is a risk factor for testicular cancer. A cohort study of more than 50,000 couples evaluated for infertility in California between 1967 and 1998 found that men with male factor infertility were more likely to develop testicular cancer than men without infertility (HR 2.8, 95 % CI 1.3-6.0) . However, given the low incidence of testicular cancer, a testicular mass found during an infertility evaluation is far more likely to be benign than malignant [11,12].
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