Testicular cancer incidence to rise by 25% by 2025 in Europe? Model-based predictions in 40 countries using population-based registry data

https://doi.org/10.1016/j.ejca.2013.11.035Get rights and content

Abstract

Background

Testicular cancer mainly affects White Caucasian populations, accounts for 1% of all male cancers, and is frequently the most common malignancy among young adult men. In light of the escalating rates of testicular cancer incidence in Europe, and in support of future planning to ensure optimal care of patients with what can be a curable disease, we predict the future burden in 40 European countries around 2025.

Methods

Current observed trends were extrapolated with the NORDPRED model to estimate the future burden of testicular cancer in the context of changes in risk versus changes in demographics.

Findings

Despite substantial heterogeneity in the rates, the vast majority of European countries will see an increasing burden over the next two decades. We estimate there will be 23,000 new cases of testicular cancer annually in Europe by 2025, a rise of 24% from 2005. Some of the most rapid increases in testicular cancer are observed in Croatia, Slovenia, Italy and Spain, and a transition is underway, whereby recent attenuations and declines in rates in certain high-risk countries in Northern Europe contrast with the increasing trends and escalating burden in Southern Europe. According to our estimates for 2025, around one in 100 men will be diagnosed with the disease annually in the highest risk countries of Europe (Croatia, Slovenia and Norway).

Interpretation

Elucidating the key determinants of testicular cancer and the equitable provision of optimal care for patients across Europe are priorities given the steady rise in the number of patients by 2025, and an absence of primary prevention opportunities.

Funding

None.

Introduction

Over 52,000 new cases of testicular cancer were estimated worldwide in 2008 [1]. The disease affects mainly White Caucasian populations, with rates in several of the highest-risk populations in Europe (Switzerland, Norway and Denmark) ten times those observed in most populations residing in Asia and Africa [2]. Within European countries, testicular cancer incidence rates vary sevenfold [3], and account for 1% of all male cancers. It is frequently the most common malignancy among young adult men (aged 15–34).

Attention was first drawn to rises in testicular cancer in England and Wales [4], and Denmark [5] half a century ago; numerous reports subsequently emerged detailing the rapid and general increases in incidence rates in adolescent men and young adults in many European countries over the last few decades [6], [7], [8], [9], [10] with testicular cancer trends mainly driven by birth cohort effects [8], [11], [12], [13]. Reasons for the distinct geographical and temporal variations in testicular cancer incidence are still however not well understood.

In light of the escalation in testicular cancer incidence in many populations and the high curability of the disease if adequate treatment regimens are adopted, we predict the future burden in 40 European countries for the year 2025 to support decision makers in resource allocation and planning for the optimal care of patients. Based on age-period-cohort models, we extrapolate the observed trends or make regional assumptions to quantify the future burden using, where possible, the high-quality data from population-based cancer registries across Europe. We highlight the increase in incidence rates and the number of future patients requiring care in terms of changes in risk versus changes in population ageing and growth. The results are discussed in the context of disease aetiology and the prospects for prevention and treatment of testicular cancer.

Section snippets

Data sources

We extracted the number of testicular cancer incidence (ICD10 C62) by year of diagnosis and 5-year age group from several sources. Firstly, data series from regional or national population-based cancer registries in Europe were extracted from Cancer Incidence in Five Continents (CI5) Volumes I to IX [2]. The specific requirement for the inclusion of a registry was at least fifteen consecutive years of data available alongside compilation in the latest Volume (IX) of the CI5 series. This

Results

The observed and predicted trends in the age-standardised incidence rates (ASR) of testicular cancer are presented in Fig. 1, for 23 European countries, and the rates circa 2005 and 2025 are compared in Fig. 2. While there is remarkable heterogeneity in the observed incidence rates between countries and regions, a general increase in rates in the range of 20–70% is predicted for most countries. The exceptions are predominantly in some Northern and Western European countries like in Denmark,

Discussion

We predict that by 2025, there will be almost 23,000 new cases of testicular cancer in Europe per year, a rise of almost 24% from the estimated 18,400 cases in 2005. Despite substantial heterogeneity in the rates of the disease in the recorded past and the predicted future, the vast majority of European countries will see an increasing burden over the next two decades. The predicted increase is seen in 20 of the 23 populations with recorded incidence data, estimated at over 20% over the two

Conflict of interest statement

None declared.

Acknowledgements

This work was developed at the International Agency for Research on Cancer (IARC, http://www.iarc.fr). No specific funding was received for this study. Ms Le Cornet is partially supported by a collaborative research agreement between IARC and Centre Léon Bérard (NORDTEST project). The authors gratefully acknowledged the following cancer registries who have contributed in sharing their data needed as baseline for incidence prediction: Austria – Austrian Cancer Registry(Mrs Zielonke); Landes

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