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Screening for testicular cancer

Kenneth W Lin, MD, MPH
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Michael E Ross, MD


Testicular cancer is the most common malignancy in males between the ages of 15 and 35 years [1]. 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 [1]. The age-adjusted incidence and death rates of testicular cancer were 5.6 cases and 0.3 deaths per 100,000 men per year [5]. Worldwide, the incidence and death rates for testicular cancer were similar: 4.6 cases and 0.3 deaths per 100,000 men per year [6]. 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 [7]. 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 [1]. 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 [8]. (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 [9]. 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) [10]. 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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Literature review current through: Sep 2016. | This topic last updated: Apr 15, 2016.
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  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66:7.
  2. McGlynn KA, Devesa SS, Sigurdson AJ, et al. Trends in the incidence of testicular germ cell tumors in the United States. Cancer 2003; 97:63.
  3. Townsend JS, Richardson LC, German RR. Incidence of testicular cancer in the United States, 1999-2004. Am J Mens Health 2010; 4:353.
  4. Huyghe E, Matsuda T, Thonneau P. Increasing incidence of testicular cancer worldwide: a review. J Urol 2003; 170:5.
  5. http://seer.cancer.gov/csr/1975_2012/ (Accessed on April 04, 2016).
  6. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin 2011; 61:69.
  7. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2008. National Cancer Institute, Bethesda, MD 2011. Available at: http://seer.cancer.gov/statfacts/html/testis.html (Accessed on October 04, 2011).
  8. Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol 2004; 22:2.
  9. Richiardi L, Pettersson A, Akre O. Genetic and environmental risk factors for testicular cancer. Int J Androl 2007; 30:230.
  10. Walsh TJ, Croughan MS, Schembri M, et al. Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med 2009; 169:351.
  11. Eifler JB Jr, King P, Schlegel PN. Incidental testicular lesions found during infertility evaluation are usually benign and may be managed conservatively. J Urol 2008; 180:261.
  12. Toren PJ, Roberts M, Lecker I, et al. Small incidentally discovered testicular masses in infertile men--is active surveillance the new standard of care? J Urol 2010; 183:1373.
  13. Peterson AC, Bauman JM, Light DE, et al. The prevalence of testicular microlithiasis in an asymptomatic population of men 18 to 35 years old. J Urol 2001; 166:2061.
  14. Shaw J. Diagnosis and treatment of testicular cancer. Am Fam Physician 2008; 77:469.
  15. National Cancer Institute. Testicular cancer treatment (PDQ) summary: health professional version. National Cancer Institute, Bethesda, MD 2011. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/testicular/HealthProfessional (Accessed on October 11, 2011).
  16. van Dijk MR, Steyerberg EW, Habbema JD. Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: An update based on meta-analysis. Eur J Cancer 2006; 42:820.
  17. Lin K, Sharangpani R. Screening for testicular cancer: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2010; 153:396.
  18. Kawakami T, Okamoto K, Ogawa O, Okada Y. XIST unmethylated DNA fragments in male-derived plasma as a tumour marker for testicular cancer. Lancet 2004; 363:40.
  19. Ilic D, Misso ML. Screening for testicular cancer. Cochrane Database Syst Rev 2011; :CD007853.
  20. National Cancer Institute: PDQ® Testicular Cancer Screening. Bethesda, MD: National Cancer Institute. Date last modified 03/04/2016. Available at: . http://www.cancer.gov/types/testicular/hp/testicular-screening-pdq (Accessed on April 06, 2016).
  21. US Preventive Services Task Force. U.S. Preventive Services Task Force. In: Guide to Clinical Preventive Services, 2nd ed, US Department of Health and Human Services, Washington, DC 1996. p.153.
  22. U.S. Preventive Services Task Force. Screening for testicular cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2011; 154:483.
  23. American Academy of Family Physicians. Summary of Recommendations for Clinical Preventive Services. Leawood, KS 2011. Available at: http://www.aafp.org/online/etc/medialib/aafp_org/documents/clinical/CPS/rcps08-2005.Par.0001.File.tmp/May2011CPS060611.pdf (Accessed on October 04, 2011).
  24. COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE and, BRIGHT FUTURES PERIODICITY SCHEDULE WORKGROUP. 2016 Recommendations for Preventive Pediatric Health Care. Pediatrics 2016; 137:1.
  25. American Cancer Society. American Cancer Society guidelines for the early detection of cancer. Atlanta 2011. Available at: http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer (Accessed on October 04, 2011).
  26. Guidelines on Testicular Cancer. European Association of Urology. http://uroweb.org/gls/pdf/Testicular%20Cancer%202010.pdf (Accessed on September 23, 2011).