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Interpreting the international trends in testicular seminoma and nonseminoma incidence

Nature Clinical Practice Urology volume 3, pages 532–543 (2006)Cite this article

Abstract

There are considerable geographic, ethnic and temporal variations in the global incidence of testicular cancer. The disease mainly affects Western populations, with average rates in developed areas of the world six times higher than those in developing areas. About 500,000 new cases were diagnosed worldwide in 2002, with the vast majority being germ cell tumors and occurring in young adult males. Traditionally, these tumors are further classified into seminoma and nonseminoma. In this Review, trends in the incidence of germ cell tumors are examined using high-quality cancer-registry data from 41 populations within 14 countries worldwide. To assess whether trends of seminoma and nonseminoma incidence are similar, data were analyzed by birth cohort. These analyses should reveal similar trends if the 10-year difference in the clinical manifestation of cancer between subtypes is caused by differences in the speed of progression from the same early rate-limiting step to the onset of symptomatic disease. In each country, incidence has uniformly increased in successive generations born from around 1920 until very recently. Cohort-specific trends in seminoma incidence are similar to cohort-specific trends in nonseminoma incidence, lending support to the conclusion that the subtypes are epidemiologically and etiologically comparable. The findings presented are related to current theories and evidence regarding the determinants of testicular germ cell cancer.

Key Points

  • A 10-year difference in the clinical manifestation of seminoma and nonseminoma is likely to be the result of disparities in the speed of progression from the same early rate-limiting step to the onset of symptomatic disease

  • With a few notable exceptions, there have been global increases in the incidence of testicular germ cell cancer in successive generations of men born from around 1920 until around the 1960s.

  • The trends in seminoma and nonseminoma incidence by birth cohort are similar, supporting the inference that seminoma and nonseminoma are epidemiologically and aetiologically similar

  • Future studies should focus on generating and testing specific hypotheses that might find the major determinant(s) of testicular cancer

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Figure 1: Scatterplot of truncated age-standardized (world) rates per 100,000 male-years of seminoma versus nonseminoma in men aged 15–54 years and diagnosed in most recent 5-year period.
Figure 2: Incidence-rate ratios of testicular germ cell cancer overall (black line), for seminoma (broken line), and nonseminoma (grey line), by birth cohort in selected North American populations, assuming an overall period slope of zero.
Figure 3: Incidence-rate ratios of testicular germ cell cancer overall (black line), for seminoma (broken line), and nonseminoma (grey line), by birth cohort in selected European populations, assuming an overall period slope of zero.
Figure 4: Incidence-rate ratios of testicular germ cell cancer overall (black line), for seminoma (broken line), and nonseminoma (grey line), by birth cohort in selected Asian and Australasian populations, assuming an overall period slope of zero.
Figure 5: Lexis diagram of 10-year birth cohorts that correspond to the 5-year periods (1955–1999) and age classes (15–54 years) for which data were available for Finland.

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Acknowledgements

The analyses and the interpretation of these trends would not be possible were it not for the dedicated work of cancer registries worldwide in providing the high quality data compiled in successive volumes of “Cancer Incidence in Five Continents” for such purposes.

Author information

Authors and Affiliations

  1. researcher based at the Cancer Registry of Norway, Oslo, Norway

    Freddie Bray

  2. staff scientist at the International Agency for Research on Cancer, Lyon, France

    Jacques Ferlay

  3. Senior Investigator and KA McGlynn is an investigator at the National Cancer Institute, Besthesda, MD, USA

    Susan S Devesa & Katherine A McGlynn

  4. Professor of Cancer Epidemiology and is based at Kings College London and the London School of Hygiene and Tropical Medicine, London, UK

    Henrik Møller

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  1. Freddie Bray
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  2. Jacques Ferlay
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  3. Susan S Devesa
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Correspondence to Freddie Bray.

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The authors declare no competing financial interests.

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Bray, F., Ferlay, J., Devesa, S. et al. Interpreting the international trends in testicular seminoma and nonseminoma incidence. Nat Rev Urol 3, 532–543 (2006). https://doi.org/10.1038/ncpuro0606

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