International Trends in the Incidence of Testicular Cancer: Lessons from 35 Years and 41 Countries

Overview

Journal Eur Urol

Specialty Urology

Date 2019 Jul 21

PMID 31324498

Citations 73

Authors

Jason K Gurney

Andrea A Florio

Ariana Znaor

Jacques Ferlay

Mathieu Laversanne

Diana Sarfati

Freddie Bray

Katherine A McGlynn

Affiliations

Soon will be listed here.

Abstract

Background: Incidence rates of testicular cancer (TC) have been increasing in many countries since, at least, the mid-20th century without clear explanation. Examining the varying trends across countries and time provides clues to understanding the causes of TC.

Objective: We have presented incidence data from 41 countries and evaluated incidence trends for the 35-yr period from 1978 to 2012.

Design, Setting, And Participants: Cancer registry data from Cancer Incidence in Five Continents (CI5) volumes V-XI, CI5plus, and the NORDCAN database were analysed.

Outcome Measurements And Statistical Analysis: Age-standardised rates of TC overall and by histological type were calculated. A joinpoint regression model of the natural log-transformed rates was used to calculate the average annual percent change (AAPC) in incidence. Age-period-cohort modelling was used to examine the effect of birth cohort on rates.

Results And Limitations: While the highest incidence of TC remains in Northern Europe, the gap is closing between higher- and lower-incidence regions. Age-period-cohort modelling found flattening of risk among recent cohorts in Denmark and the UK, a steady increase in risk in the USA (particularly for seminomas), and an increase in risk among more recent cohorts in Costa Rica, Croatia, and Slovakia.

Conclusions: The gap between low- and high-incidence countries is closing due to increases in the former and stabilisation in the latter. Understanding the causes of these and other differences in incidence rates between, and within, countries may help further our understanding of the aetiology of this cancer.

Patient Summary: We examined the rates of testicular cancer in different countries over time. These rates have been increasing, although the rates in high-incidence countries seem to be slowing down, while rates in low-incidence countries are catching up. These trends might help us understand what is causing testicular cancer in general.

Citing Articles

The Urogenital System Microbiota: Is It a New Gamechanger in Urogenital Cancers?.

Ece G, Aktas A, Caner A, Saglik I, Kula Atik T, Ulusan Bagci O Microorganisms. 2025; 13(2).

PMID: 40005682 PMC: 11858393. DOI: 10.3390/microorganisms13020315.

Networks of pre-diagnostic circulating RNA in testicular germ cell tumour.

Burton J, Rounge T, Haugen T, Wojewodzic M Sci Rep. 2025; 15(1):1910.

PMID: 39809819 PMC: 11733264. DOI: 10.1038/s41598-024-84484-z.

Racial/ethnic differences in trends of testicular germ cell tumor incidence in the United States, 1992-2021.

Almeida A, Wojt A, Metayer C, Kanetsky P, Graubard B, Alvarez C Cancer. 2025; 131(2):e35706.

PMID: 39760469 PMC: 11702318. DOI: 10.1002/cncr.35706.

Trends in incidence and demographics of testicular cancer in California, 2000-2020.

Benjamin D, Shrestha A, Fellman D, Kalebasty A BJUI Compass. 2025; 5(12):1249-1251.

PMID: 39744080 PMC: 11685165. DOI: 10.1002/bco2.451.

Potential next generation markers of testicular germ cell tumors: miRNA-371a-3p.

Zujuan S, Xin D, Yang H, Guifu Z Int Urol Nephrol. 2024; 57(3):691-700.

PMID: 39576421 DOI: 10.1007/s11255-024-04284-2.

References

Le Cornet C, Lortet-Tieulent J, Forman D, Beranger R, Flechon A, Fervers B . Testicular cancer incidence to rise by 25% by 2025 in Europe? Model-based predictions in 40 countries using population-based registry data. Eur J Cancer. 2013; 50(4):831-9. DOI: 10.1016/j.ejca.2013.11.035. View

Bray F, Richiardi L, Ekbom A, Forman D, Pukkala E, Cuninkova M . Do testicular seminoma and nonseminoma share the same etiology? Evidence from an age-period-cohort analysis of incidence trends in eight European countries. Cancer Epidemiol Biomarkers Prev. 2006; 15(4):652-8. DOI: 10.1158/1055-9965.EPI-05-0565. View

Speaks C, McGlynn K, Cook M . Significant calendar period deviations in testicular germ cell tumors indicate that postnatal exposures are etiologically relevant. Cancer Causes Control. 2012; 23(10):1593-8. PMC: 3461587. DOI: 10.1007/s10552-012-0036-5. View

Trabert B, Chen J, Devesa S, Bray F, McGlynn K . International patterns and trends in testicular cancer incidence, overall and by histologic subtype, 1973-2007. Andrology. 2014; 3(1):4-12. PMC: 4410839. DOI: 10.1111/andr.293. View

Fossa S . Long-term sequelae after cancer therapy--survivorship after treatment for testicular cancer. Acta Oncol. 2004; 43(2):134-41. DOI: 10.1080/02841860310023174. View

Kim C, McGlynn K, McCorkle R, Li Y, Erickson R, Ma S . Sexual functioning among testicular cancer survivors: a case-control study in the U.S. J Psychosom Res. 2012; 73(1):68-73. PMC: 3374934. DOI: 10.1016/j.jpsychores.2012.02.011. View

Puhse G, Wachsmuth J, Kemper S, Husstedt I, Evers S, Kliesch S . Chronic pain has a negative impact on sexuality in testis cancer survivors. J Androl. 2011; 33(5):886-93. DOI: 10.2164/jandrol.110.012500. View

Horwich A, Shipley J, Huddart R . Testicular germ-cell cancer. Lancet. 2006; 367(9512):754-65. DOI: 10.1016/S0140-6736(06)68305-0. View

Znaor A, Lortet-Tieulent J, Jemal A, Bray F . International variations and trends in testicular cancer incidence and mortality. Eur Urol. 2013; 65(6):1095-106. DOI: 10.1016/j.eururo.2013.11.004. View

10.

Bray F, Richiardi L, Ekbom A, Pukkala E, Cuninkova M, Moller H . Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality. Int J Cancer. 2006; 118(12):3099-111. DOI: 10.1002/ijc.21747. View

11.

Winter C, Albers P . Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nat Rev Endocrinol. 2010; 7(1):43-53. DOI: 10.1038/nrendo.2010.196. View

12.

Shah M, Devesa S, Zhu K, McGlynn K . Trends in testicular germ cell tumours by ethnic group in the United States. Int J Androl. 2007; 30(4):206-13. DOI: 10.1111/j.1365-2605.2007.00795.x. View

13.

Coupland C, Chilvers C, Davey G, Pike M, Oliver R, Forman D . Risk factors for testicular germ cell tumours by histological tumour type. United Kingdom Testicular Cancer Study Group. Br J Cancer. 1999; 80(11):1859-63. PMC: 2363133. DOI: 10.1038/sj.bjc.6690611. View

14.

Gurney J, Sarfati D, Stanley J . Obscure etiology, unusual disparity: the epidemiology of testicular cancer in New Zealand. Cancer Causes Control. 2015; 26(4):561-9. DOI: 10.1007/s10552-015-0533-4. View

15.

Brydoy M, Fossa S, Klepp O, Bremnes R, Wist E, Wentzel-Larsen T . Paternity following treatment for testicular cancer. J Natl Cancer Inst. 2005; 97(21):1580-8. DOI: 10.1093/jnci/dji339. View

16.

Kim H, Fay M, Feuer E, Midthune D . Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000; 19(3):335-51. DOI: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z. View

17.

Rajpert-De Meyts E, McGlynn K, Okamoto K, Jewett M, Bokemeyer C . Testicular germ cell tumours. Lancet. 2015; 387(10029):1762-74. DOI: 10.1016/S0140-6736(15)00991-5. View

18.

Parkin D, Bray F . Evaluation of data quality in the cancer registry: principles and methods Part II. Completeness. Eur J Cancer. 2009; 45(5):756-64. DOI: 10.1016/j.ejca.2008.11.033. View

19.

Bray F, Parkin D . Evaluation of data quality in the cancer registry: principles and methods. Part I: comparability, validity and timeliness. Eur J Cancer. 2009; 45(5):747-55. DOI: 10.1016/j.ejca.2008.11.032. View

20.

Chia V, Quraishi S, Devesa S, Purdue M, Cook M, McGlynn K . International trends in the incidence of testicular cancer, 1973-2002. Cancer Epidemiol Biomarkers Prev. 2010; 19(5):1151-9. PMC: 2867073. DOI: 10.1158/1055-9965.EPI-10-0031. View