Testicular cancer - UK incidence statistics

Testicular cancer has several distinct features when compared with other cancers. Firstly, it has an unusual age-distribution, occurring most commonly in young and middle-aged men. Secondly, its incidence is rising, particularly in white Caucasian populations throughout the world, for reasons as yet unknown. And thirdly, testicular cancer is curable in the majority of cases.

Testicular cancer is a relatively rare cancer with 2,138 new cases registered in 2008 in the UK. 1-4 It is responsible for just over 1% of all male cancers. It has been estimated that the lifetime risk of developing testicular cancer in 2008 is 1 in 199 for men in the UK. This was done using the AMP method. 27 Table 1.1 shows the numbers and rates for the UK and its constituent countries. 1-4

Table 1.1: Testicular Cancer (C62), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2008

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*95% LCL and 95% UCL are the 95% lower and upper confidence limits around the AS Rate

section updated 01/08/11

Around half (47%) of all cases occur in men under 35 years and over 90% occur in men under 55 years. Testicular cancer rarely occurs before puberty but it is the most common cancer in men aged 15-44 years. Incidence rates peak at around 17 or 18 per 100,000 in the 25-34 age group (Figure 1.1). 1-4

Figure 1.1:  Testicular Cancer (C62), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2006-2008

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This pattern of higher rates in younger men gradually developed during the twentieth century (see Figure 2.2 in the Mortality section).

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95% of testicular tumours are germ-cell tumours (GCTs), 4% are lymphomas and the remaining 1% is composed of various rare histologies. Lymphomas are nearly always found in men aged over 50 and are generally treated as a different disease entity from GCTs.

GCTs can be divided into two main groups: about 40-45% are seminomas and a similar percentage are nonseminomas.

The nonseminoma group contains a variety of histological subtypes including malignant teratoma differentiated (MTD), malignant teratoma intermediate (MTI) and malignant teratoma undifferentiated (MTU).

Nonseminomas tend to occur on average ten years earlier than seminomas. Incidence of nonseminomas peaks in the 20-35 age group while incidence of seminomas peaks in the 30-45 age group. Some GCTs (10-15%) are a mixture of seminoma and nonseminoma and have a peak age incidence halfway between the nonseminomas and seminomas. They are usually classified and treated as nonseminomas.

GCTs are thought to develop from a non-invasive lesion called carcinoma in situ (CIS) of the testis (also called intratubular germ-cell neoplasia unclassified (IGCNU) and testicular intraepithelial neoplasia (TIN)), whose malignant transformation is likely to be influenced by hormones at or after puberty. 5, 6

section updated 31/12/09

Data from men diagnosed in England between 2000 and 2004 show a deprivation gradient, with the highest incidence rates in the least deprived groups (7.2 cases per 100,000 in the least deprived compared with 5.5 in the most deprived). 7 However, there was no clear trend for Scottish data between 1986 and 1995. 8

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Although the incidence of testicular cancer is low throughout the world, it is estimated to have doubled in the last 40 years and there is appreciable variation between countries. 9

The highest rates of testicular cancer are reported for white Caucasian populations in industrialised countries, particularly in western and northern Europe and Australia/New Zealand, (Figure 1.2), while the disease is generally rare in non-Caucasian populations - the New Zealand Maoris being the exception. 10, 11

Figure 1.2: Testicular Cancer (C62), World Age-Standardised Incidence and Mortality Rates, World Regions, 2008 Estimates

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• Overall, rates of testicular cancer in the developed regions of the world are five times higher than those in the less developed regions. Within North America, the consistently lower rates reported for black Americans compared with white Americans suggest a genetic component to the disease, while the rates for Asian and Hispanic men are intermediate between those of white and black Americans. 12

Within the European Union (EU), there is an approximately five-fold variation in incidence between countries with the highest and lowest incidence rates. For example, Denmark reports age-standardised rates (ASRs) of around 10 per 100,000, while Romania and Greece have ASRs of less than 2 per 100,000. The UK ASR (6.9 per 100,000) is above the EU average. (Figure 1.3) 13

Figure 1.3: Testicular Cancer (C62), European Age-Standardised Incidence and Mortality Rates, EU-27 Countries, 2008 Estimates

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Across the UK, higher rates of testicular cancer are reported in Scotland and the south of England, where incidence rates are more than 8 per 100,000 men. Rates in the north of England are around 7 per 100,000, and in eastern England and London around 6 per 100,000. 14 Lower rates recorded in urban areas may reflect the fact that urban populations generally have a higher percentage of minority ethnic groups with a lower testicular cancer risk than the general UK population.

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Large increases in incidence of testicular cancer have been reported in many countries around the world over the last 40 years including the USA,15 Canada,16 Europe,17 Nordic countries,18 Australia19 and the UK. 20-22

On average, the increases are 1-6% per annum and are reported for both seminomas and nonseminomas. 17 Rises are mainly in young, white Caucasian populations, but since 1988, incidence for young, black Americans has also increased. 23

These trends appear to be influenced more by birth-cohort than period effects, with increasing risk for each generation of men born from the 1920s until the 1960s. 24

A dip in this continuous rise was recorded for men born during World War II in Denmark and Norway, who had a lower risk of testicular cancer than either previous or subsequent birth cohorts, suggesting that environmental and lifestyle factors affect risk.

For high risk countries there is evidence that the rate of increase has slowed over time 15,25 and in several countries, including the UK, the most recent testicular cancer incidence rates have fallen slightly. 18

One exception to these trends is Switzerland, where the testicular cancer incidence rate is one of the highest in Europe. The rate has risen only slightly, from around 8.5 per 100,000 males in the 1970s and 1980s to 10 per 100,000 in the 1990s, with no evidence of further increase. 25

Analysis of testicular cancer incidence trends by histology in eight European countries, including the UK, concluded that the trends were similar for both seminomas and nonseminomas and were based on birth cohort effects. However the declining rates seen in the 1990s in Switzerland, Denmark, Norway, Italy and Sweden were for nonseminomas only, a situation also reported for the USA. 15,26 As these tumours are diagnosed on average ten years before seminomas, it is possible that a decline in seminoma incidence will lag by ten years.

In Great Britain, the increase in testicular cancer rates between 1975 and 2008 is shown in Figure 1.4. 1-3

Figure 1.4: Testicular Cancer (C61), European Age-Standardised Incidence Rates, Great Britain, 1975-2008

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The annual average number of new cases of testicular cancer in Great Britain more than doubled, from 859 in 1975-77 to 2,091 in 2006-2008. The incidence rates show a similar trend rising steadily from 3.4 per 100,000 males in 1975-77 to 6.9 per 100,000 in 2006-2008. 1-3

The UK trend is shown in Figure 1.5. 1-4

Figure 1.5: Testicular Cancer (C61), European Age-Standardised Incidence Rates, UK, 1993-2008

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When the rates are analysed by age, it is evident that the increase has occurred mainly in men under 60 years (Figure 1.6). 1-3 Rates in all age groups under 60 have doubled; the greatest increase was in men aged 45-59 from 2.8 per 100,000 males in 1975 to 6.3 per 100,000 in 2008.

Figure 1.6: Testicular Cancer (C61), European Age-Standardised Incidence Rates, by Age, Great Britain, 1975-2008

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section updated 01/08/11

Prevalence data relate to those people in the UK population who were alive on a specific date having previously been diagnosed with cancer. The latest analysis shows that on 31st December 2006, around 18,500 men were alive up to ten years after being diagnosed with testicular cancer. 28 Table 1.2 shows the one, five and ten year prevalence for testicular cancer.

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section updated 13/06/10