Incidence rates for testicular cancer have been rising in the United States, as have related mortality rates, but there are wide variations by race/ethnicity and geographic location, a new analysis shows.
Testicular cancer is the most common type of malignancy in young men between the ages of 20 and 34 years, although overall, it is relatively uncommon and represents only 0.5% of all new cancer cases in the US.
The new analysis shows that age-adjusted testicular cancer–specific mortality rates in the United States increased from 1999 to 2019, particularly among Hispanic men. During the same period, mortality rates declined somewhat among Black men as compared to White men.
"Given that testicular cancer generally has a favorable prognosis, it is concerning that mortality rates for this disease are increasing," said lead author Anushka Ghosh, BS, a clinical research coordinator at Massachusetts General Hospital, Boston. "It is crucial to understand these trends and make targeted efforts to address any geographic, racial, and ethnic gaps in testicular cancer care."
She presented the findings at the Genitourinary Cancers Symposium (GUCS) 2022.
"Testicular cancer is a rare but very curable disease," said Daniel Geynisman, MD, associate professor in the Department of Hematology/Oncology at Fox Chase Cancer Center, who was approached for comment. "The increase in testicular cancer deaths for Hispanic men is concerning.
"Whether this change relates to suboptimal access to appropriate care or change in biology as a result of socioeconomic or geographic changes in Hispanic men over the recent years is unknown but needs to be urgently explored and addressed," he added.
Details of the New Findings
For their analysis, Ghosh and colleagues assessed recent changes in testicular cancer mortality rates over time in the United States with respect to race, ethnicity, and geography. They used the Centers for Disease Control's Wide-Ranging Online Data for Epidemiologic Research database to obtain the number of age-adjusted death rates for individuals across all US counties over a 21-year period (1999–2019).
During this period, overall age-adjusted testicular cancer mortality rates rose slowly but not significantly, with an overall increase of 0.0002 per 100,000 population per year. This increase was significantly worse among Hispanic men, among whom the increase was 0.0019 per 100,000, compared with a 0.0003 per 100,000 decrease among non-Hispanic men (comparison P = .010).
But when stratified by race (Black vs White), the authors saw that Black men had somewhat improved rates. Among Black men, the rate decreased by 0.0007 per 100,000, compared with an increase of 0.0006 per 100,000 among White men, a difference that reached statistical significance (P = .049).
"We also observed significant geographical differences in mortality rates," said Ghosh.
They divided the US into four regions: the Northeast, the Midwest, the South, and the West. There were no differences in the South and the Midwest, but mortality rates decreased in the Northeast by 0.00092 per 100,000 and rose in the West by 0.00086 per 100,000 (P for difference between slopes = .032).
The authors also looked at differences in urbanization categories or population density and found that large central metro regions (central counties in metro areas with population >1 million) and small metro regions (counties with population 50,000–249,999) were significantly different. While testicular cancer mortality rates decreased slightly in large central metropolitan regions by 0.0004, rates increased slightly in small metropolitan regions (0.0022; P for difference = .048). No other significant differences based on urbanization were noted.
Also approached for comment, Matt D. Galsky, MD, director of genitourinary medical oncology at the Tisch Cancer Institute at Mount Sinai, noted that the finding that testicular cancer mortality rates increased from 1999–2019 was not statistically significant.
However, there were significant trends among subgroups. Testicular cancer mortality increased during this period among Hispanic men, he pointed out. "Importantly, while statistically significant, the differences are numerically small. That said, testicular cancer is a generally a highly curable malignancy, and so any disparities related to mortality may be notable and worth further investigation.
"There are several potential underlying causes of such disparities, some of which could be probed with additional clinical details, and some of which might involve a more complex interplay of access and tumor biology," he continued. "For example, testicular cancer are broadly separated into two subtypes: seminoma and nonseminoma. Whether the trends in these two subtypes in Hispanic men are different compared to non-Hispanic men could be one clue into the observed disparities."
Ghosh, Geynisman, and Galsky have disclosed no relevant financial relationships.
2022 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium: Abstract 409. Presented February 18, 2022
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