Cancer Research UK : UK Testicular Cancer incidence statistics

UK Testicular Cancer incidence statistics

This page presents testicular cancer incidence statistics by age and sex, histology, socio-economic deprivation, geographical variation and trends.The ICD code for testicular cancer is ICD9 186, and ICD 10 C62.

Testicular cancer is a relatively rare cancer with 2,000 new cases registered each year in the UK.1-4 It is responsible for 1–2% of all male cancers.

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 incidence by age

In 2005 there were around 2,109 new cases of testicular cancer diagnosed in the UK.4-7 Table 1.1 shows the numbers and rates for the UK and its constituent countries.1-4

Table showing the number of new cases and rates of testicular cancer in the UK

Download this table (31.5KB)

Around half 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 per 100,000 in the 25–34 age group (Figure 1.1).1-4

Figure showing the numbers of new cases and age-specific incidence rates of males for testicular cancer in the UK

Download this chart (36.0KB)

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

Testicular cancer histology

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

Socio-economic deprivation and testicular cancer incidence

Data from men diagnosed in England and Wales between 1991 and 1993 show a small deprivation gradient, with the highest incidence rates in the least deprived groups.7 However, there was no clear trend for Scottish data between 1986 and 1995.8

Geographic variation in testicular cancer incidence

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 (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: Age standardised (World) incidence rates, testicular cancer, males, regions of the world

Download this chart (17.0KB)

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, Germany and Austria report age-standardised rates (ASRs) of around 10 per 100,000, while Lithuania, Estonia, Spain and Latvia have ASRs of around 2 per 100,000 (Figure 1.3)10,13.

Figure 1.3: Age-standardised (European) incidence rates, testicular cancer, males, selected EU countries

Download this chart (17.5KB)

The UK ASR (7.1 per 100,000) is towards the upper end of those reported in the EU. A surprising finding is that there are appreciable differences between neighbouring countries and within countries. For example, the testicular cancer incidence rate in Sweden is more than double that of Finland14, and regional rates in France vary from 2.8 to 7.9 per 100,000.9

Across the UK and Ireland, higher rates of testicular cancer are reported in Scotland and the south of England, with lower rates in Ireland, London and the north of England.15 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.

Trends in testicular cancer incidence

Large increases in incidence of testicular cancer have been reported in many countries around the world over the last 40 years including the USA,16 Canada 17,Europe 18 Nordic countries,19 Australia20 and the UK.21-23

On average, the increases are 1–6% per annum and are reported for both seminomas and nonseminomas.18 Rises are mainly in young, white Caucasian populations, but since 1988, incidence for young, black Americans has also increased.24

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.25

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 16, 26 and in several countries ,including the UK, the most recent testicular cancer incidence rates have fallen slightly.19

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 in the 1970s and 1980s to 10 per 100,000 in the 1990s, with no evidence of further increase.26

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.16, 27 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 rise in the numbers of new cases of testicular cancer and the age-standardised rates (ASRs) between 1975 and 2005 is shown in Figure 1.4.13

Chart showing the number of new cases and age standardised (European) incidence rates for testicular cancer in Great Britian

Download this chart (34.5KB)

The annual number of new cases of testicular cancer in Great Britain more than doubled, from 850 to 2,046, between 1975 and 2005 although with a slight reduction between 2002-2004.

The ASRs show a similar trend rising steadily from 3.3 per 100,000 in 1975 to 7.0 per 100,000 in 2005.

When the rates are analysed by age, it is evident that the increase has occurred mainly in younger men (Figure 1.5).13

The greatest increase was for men aged 30–44: rates in this age group more than doubled from 7 per 100,000 males in 1975 to 15.5 per 100,000 in 2005.

Figure showing the age-specific incidence rates for testicular cancer in GB

Download this chart (44.0KB)

References for testicular cancer incidence

Office for National Statistics, Cancer Statistics registrations: Registrations of cancer diagnosed in 2005, England. Series MB1 no.35. 2008, National Statistics: London.
ISD Online Information and Statistics Division, NHS Scotland 2008.
Welsh Cancer Intelligence and Surveillance Unit 2008. Cancer Incidence in Wales.
Northern Ireland Cancer Registry 2008. Cancer Incidence and Mortality in Northern Ireland
Horwich, A., J. Shipley, and R. Huddart,Testicular germ-cell cancer.The Lancet, 2006. 367(9512): p. 754.
Rajpert-De Meyts, E., et al., The emerging phenotype of the testicular carcinoma in situ germ cell. Apmis, 2003. 111(1): p. 267-78; discussion 278-9.
Quinn, M., et al., Cancer Trends in England & Wales 1950-1999. Vol. SMPS No. 66. 2001: TSO.
Harris, V., et al., Cancer Registration Statistics: Scotland 1986-1995. 1998, Edinburgh: ISD Scotland Publications.
Huyghe, E., T. Matsuda, and P. Thonneau, Increasing incidence of testicular cancer worldwide: a review. J Urol, 2003. 170(1): p. 5-11.
GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide 2002 estimates.
Wilkinson, T.J., B.M. Colls, and P.J. Schluter, Increased incidence of germ cell testicular cancer in New Zealand Maoris. Br J Cancer, 1992. 65(5): p. 769-71.
SEER. Cancer Statistics Review 1975-2003. Accessed 2006
Statistical Information Team. 2007, Cancer Research UK: London.
Richiardi, L., et al., Testicular Cancer Incidence in Eight Northern European Countries: Secular and Recent Trends. Cancer Epidemiol Biomarkers Prev, 2004. 13(12): p. 2157-2166.
Quinn M, W.H., Cooper N, Rowan S (eds), Cancer Atlas of the United Kingdom and Ireland 1991-2000. Studies on Medical and Population Subjects No. 68. 2005: Palgrave Macmillan.
McGlynn, K.A., et al., Trends in the incidence of testicular germ cell tumors in the United States. Cancer, 2003. 97(1): p. 63-70.
Weir, H.K., L.D. Marrett, and V. Moravan, Trends in the incidence of testicular germ cell cancer in Ontario by histologic subgroup, 1964-1996. CMAJ, 1999. 160(2): p. 201-5.
Bray, F., et al., 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): p. 3099-111.
Jacobsen, R., et al., Trends in testicular cancer incidence in the Nordic countries, focusing on the recent decrease in Denmark. Int J Androl, 2006. 29(1): p. 199-204.
Stone, J.M., et al., Trebling of the incidence of testicular cancer in Victoria, Australia (1950-1985). Cancer, 1991. 68(1): p. 211-9.
Boyle, P., S.B. Kaye, and A.G. Robertson, Changes in testicular cancer in Scotland. Eur J Cancer Clin Oncol, 1987. 23(6): p. 827-30.
Power, D.A., et al., Trends in testicular carcinoma in England and Wales, 1971-99.BJU Int, 2001. 87(4): p. 361-5.
Toledano, M.B., et al., Spatial variation and temporal trends of testicular cancer in Great Britain. Br J Cancer, 2001. 84(11): p. 1482-7.
McGlynn, K.A., et al., Increasing Incidence of Testicular Germ Cell Tumors Among Black Men in the United States. J Clin Oncol, 2005. 23(24): p. 5757-5761.
Bray, F., et al., Interpreting the international trends in testicular seminoma and nonseminoma incidence. Nat Clin Pract Urol, 2006. 3(10): p. 532-43.
Levi, F., et al., Trends in testicular cancer incidence in Vaud, Switzerland. Eur J Cancer Prev, 2003. 12(4): p. 347-9.
Bray, F., et al., 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): p. 652-658.