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Testicular germ cell tumor incidence increased in Hispanic adolescents, young adults
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The incidence of testicular germ cell tumors increased significantly in recent years among Hispanic adolescents and young adults, yet this trend was not apparent in non-Hispanic white men, according to results of a SEER analysis.
“Hispanic Americans comprise the fastest growing ethnic group in the United States,” Rebecca H. Johnson, MD, medical director of the Adolescent and Young Adult (AYA) oncology program at Seattle Children’s Hospital and assistant professor of pediatrics at the University of Washington School of Medicine, said in a press release. “Until only recently, cancer incidence data for this population has been too sparse to accurately analyze testicular cancer trends among Hispanic men.”
Rebecca H. Johnson
Johnson and colleagues used two SEER datasets to evaluate testicular germ cell tumor incidence. One dataset spanned from a 1992 to 2010 and comprised of 15% of the US population. The other dataset spanned from 2000 to 2010 and comprised of 28% of the population.
In the first dataset, researchers identified testicular germ cell tumor cases in 3,488 Hispanic men and 15,057 non-Hispanic men. In the second dataset, they identified testicular germ cell tumor cases in 4,655 Hispanic men and 17,856 non-Hispanic men.
When researchers evaluated incidence of testicular germ cell tumors in the first dataset, they calculated an annual percentage change of 3.61 (95% CI, 3.02-4.21) among Hispanic white AYAs aged 15 to 39 years, compared with an annual percentage change of 1.04 (95% CI, 0.58-1.5) among non-Hispanic white AYAs. In the second dataset, researchers calculated an annual percentage change of 3.81 (95% CI, 2.99-4.63) among Hispanic white AYAs, but they observed no trend in incidence among non-Hispanic white AYAs.
The annual incidence of testicular germ cell tumors among Hispanic white AYAs was 7.18 cases per 100,000 males in 1992, and that rate increased 58% to 11.34 cases per 100,000 males in 2010 (P˂1x10-9). The annual incidence of testicular germ cell tumors among non-Hispanic white AYAs increased 7% during this time, from 12.41 cases to 13.22 cases per 100,000 males.
The increased incidence of testicular germ cell tumors among Hispanic white AYAs was apparent for seminoma and nonseminoma disease subtypes, and across all disease stages.
Researchers observed increased testicular germ cell tumor incidence among Hispanic AYAs only in metropolitan areas (annual percentage change, 3.7; 95% CI, 3.05-4.34) in the first dataset, yet the incidence increased in metropolitan and nonmetropolitan (annual percentage change, 6.78; 95% CI, 0.21-13.78) areas in the more recent dataset.
“The increasing rate of testicular cancer in adolescent and young adult Hispanic males, combined with the rapid expansion of the Hispanic population in the United States, is projected to have a measurable impact on the US healthcare system,” Johnson said.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Costantine Albany, MD
In this interesting paper, Chien and colleagues reported the incidence of testicular cancer among Hispanic young men in the United States between 1992 and 2010 using the SEER database. There was a significant 58% increase in the rate of both seminomas and non-seminomas testicular germ cell tumors (TGCT) in white Hispanics, compared with a 7% increase in non-Hispanic white men. The rate of TGCT among Hispanics increased from 7.18/100,000 in 1992 to 11.34/100,000 by 2010.These results are similar to a study reported by Nigam and colleagues from the University of Chicago, who analyzed the SEER13 database for the incidence of testicular cancer in the United States between 1992 and 2009 (Nigam M. Abstract #339. Presented at: Genitourinary Cancers Symposium; Feb. 14-16, 2013; Orlando, Fla.). They found significantly increasing incidence rates most prominently among Hispanics — especially from 2002-2009, when incidence increased 5.6% among Hispanics vs. 1.2% among non-Hispanic white men.
It is unclear why the incidence of TGCT is rising in general and at a higher rate among Hispanic young men. One can speculate on the role of cryptorchidism, diet change and increase in obesity; however, more research is needed to understand the underlying mechanism of this rise in the incidence of testicular cancer. Even more disturbing, there appears to be an unacceptably poor outcome seen across all stages of the disease among African-American and Hispanic patients with TGCT compared with Caucasian populations, and thus it is highly recommended that patients with testicular cancer be referred to high-volume institutions with multidisciplinary experienced teams to improve the chances of curing this disease. Also, an important message from this study is to raise awareness among Hispanic adolescents and young adults about testicular cancer and the importance of seeking medical opinion if there is pain, swelling or change in the size of the testicle. Primary care physicians also need to be aware of this trend and choose close follow-up and early testicular ultrasound for Hispanic adolescents and young adults who present with testicular mass on physical exam. Early detection and treatment can lead to cure by orchiectomy alone, sparing these young men the toxicity of chemotherapy if diagnosed at an early stage.
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