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1 Department of Medical Epidemiology and Biostatistics and 2 Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, Karolinska Institutet, 3 Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden; 4 Unit of Cancer Epidemiology, CeRMS and Center for Oncologic Prevention, University of Turin, Italy; 5 Finnish Cancer Registry, Helsinki, Finland; 6 Department of Epidemiology and Biostatistics, Institute of Experimental and Clinical Medicine and 7 National Centre for Excellence in Behavioural and Health Sciences, Tallinn, Estonia; 8 Latvian Oncology Center, Riga, Latvia; 9 Cancer Prevention & Documentation, Danish Cancer Society, Copenhagen, Denmark; 10 Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway; 11 Lithuanian Cancer Registry, Vilnius University Oncology Institute, Lithuania; and 12 Unit of Descriptive Epidemiology, IARC, Lyon, France
Requests for reprints: Lorenzo Richiardi, Cancer Epidemiology Unit, V. Santena 7, 10126, Turin, Italy. Phone: 39-011-6706526; Fax: 39-011-6706692. E-mail: lorenzo.richiardi{at}unito.it
Objective: Striking geographic variation and marked increasing secular trends characterize the incidence of testicular cancer. However, it is not known whether these patterns have attenuated in recent years and whether they are similar for seminomas and nonseminomas, the two main histologic groups of testicular cancer.
Method: Cancer registry data, including 27,030 testicular cancer cases, were obtained from Denmark, Estonia, Finland, Latvia, Lithuania, Norway, Poland, and Sweden. Between 57 (Denmark) and 9 (Poland) years of registration were covered. Country-specific temporal trends were estimated, with focus on the last decade and seminomas and nonseminomas. Data from the Nordic countries were further analyzed using an age-period-cohort approach.
Results: Age-standardized incidence rates increased annually by 2.6% to 4.9% during the study period, with marginal differences between seminomas and nonseminomas. In the last decade, the increasing trend attenuated only in Denmark (annual change, –0.3%; 95% confidence interval, –1.5 to 0.9). In 1995, the highest and the lowest age-standardized incidence rates (per 105) were 15.2 in Denmark and 2.1 in Lithuania. Incidence rates (i.e., for all cancers and for seminomas and nonseminomas, separately) depended chiefly on birth cohort rather than on calendar period of diagnosis (although both birth cohort and period determined the Danish incidence rates).
Conclusions: Testicular cancer incidence is still increasing, with the exception of Denmark, and a large geographic difference exists. The increasing trend is mainly a birth cohort phenomenon also in recent cohorts. Temporal trends for seminomas and nonseminomas are similar, which suggests that they share important causal factors.
Key Words: testicular cancer • incidence • temporal trends • seminomas • nonseminomas • age-period-cohort analysis
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