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Fertility Among Brothers of Patients with Testicular Cancer

¹ Cancer Epidemiology Unit, CeRMS and Center for Oncology Prevention, University of Turin, Turin, Italy and ² Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden

Requests for reprints: Lorenzo Richiardi, Cancer Epidemiology Unit, CeRMS and Center for Oncology Prevention, University of Turin, V Santena 7, 10126, Turin, Italy. Phone: 39-011-633-4628; Fax: 39-011-633-4664. E-mail: lorenzo.richiardi{at}unito.it

Objective: Patients with testicular cancer have decreased fertility prior to the diagnosis of cancer, although it is not clear whether the subfertility is the result of an emerging tumor, or whether subfertility and testicular cancer share causes. To test if they share causes, we assessed fertility among brothers of patients with testicular cancer.

Methods: We compared 5,613 siblings (2,878 brothers) of patients with germ-cell testicular cancer, diagnosed in Sweden from 1960 to 2002, with 6,151 population controls (3,202 men). Using the Swedish Multi-Generation Register, we obtained information on the number of children born (until December 2003) from cases (n = 9,480) and controls (n = 10,739). Fertility was measured using two indicators, (a) offspring twinning rates, as dizygotic twinning is reduced by male subfertility, and (b) number of children. We used unconditional logistic regression, and analyzed brothers and sisters separately. Analyses on the number of children were restricted to subjects (39%) born prior to 1954, for whom information on reproductive life until age 50 was available.

Results: Brothers, but not sisters, of patients with testicular cancer were less likely to have unlike-sex twins than controls (for unlike-sex twins, the odds ratio for the father being a sibling of testicular cancer patient was 0.53; 95% confidence interval, 0.26-1.09). The likelihood of being a brother of a patient with testicular cancer decreased monotonically with increasing number of children (P = 0.05), whereas no association was observed for the sisters.

Conclusion: The decreased fertility found among brothers of patients with testicular cancer argues in favor of shared causes between cancer-associated subfertility and testicular cancer. Genetic links and shared environment could explain the association.