International variations and trends in testicular cancer incidence and mortality.

CONTEXT: Testicular cancer (TC) is the most common cancer in men aged 15-44 yr in many countries that score high or very high on the Human Development Index (HDI). Despite the very good prognosis for TC, wide variations in mortality rates have been reported internationally.

OBJECTIVE: To describe and contrast global variations and recent trends in TC incidence and mortality rates.

EVIDENCE ACQUISITION: To compare TC incidence and mortality rates, we used GLOBOCAN 2008 estimates. We used the Cancer Incidence in Five Continents series to analyse recent trends in TC incidence in 41 countries by way of joinpoint analysis. To examine recent trends in mortality, we used the World Health Organisation mortality database.

EVIDENCE SYNTHESIS: Northern Europe remains the highest TC incidence area, with the highest rates observed in Norway and Denmark. Incidence rates continue to increase in most countries worldwide, more markedly in Southern Europe and Latin America, while attenuating in Northern Europe, the United States, and Australia. Mortality from TC shows a different pattern, with higher rates in some countries of medium to high HDI. The highest mortality rates were seen in Chile and Latvia, as well as in selected Central European and Eastern European countries. In high-income countries, TC mortality rates are declining or stable at very low levels of magnitude, while no significant decreases were observed in middle-income regions in Latin America and Asia.

CONCLUSIONS: The rises in TC incidence appear to be recently attenuating in countries with the highest HDIs, with corresponding mortality rates either continuing to decline or stabilising at very low levels. In a number of countries transiting towards higher levels of development, the TC incidence is increasing while mortality rates are stable or increasing.

PATIENT SUMMARY: In this study we looked at international testicular cancer trends. We found that testicular cancer is becoming more common in low- and middle-income countries, where the optimal treatment might not yet be available.