Established risk factors for testicular cancer

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In addition to a family history of testicular cancer, there are two other known risk factors:  cryptorchidism (undescended testicle) and a personal history of testicular cancer.

Up to 5 percent of boys are born with cryptorchidism. Men who have a history of cryptorchidism have a testicular cancer risk that is 2 to 8 times the normal rate. For most of those born with cryptorchidism, the testicle descends spontaneously into the scrotum within a few months of birth.

However, for the remainder the testicle does not descend on its own, and treatment (commonly with orchiopexy, a surgery that places the testicle in the scrotum) is warranted. The age at which this surgery is performed varies, but many urologists now recommend surgery before the age of one year. Orchiopexy is important for eventual sperm production; relative to testicular cancer, it allows for a testicular abnormality-such as a lump-to be felt, increasing the likelihood of early detection. 

Since cryptorchidism increases the chance of testicular cancer, can the risk of developing testicular cancer risk be reduced by orchiopexy?

If so, does the age at which orchiopexy occurs affect this risk? A study of close to 17,000 men in Sweden compared the testicular cancer risk in those who underwent orchiopexy before the age of 13 to those who had surgery at 13 years or older (approximately pre- vs. postpuberty) and found that early surgery halved the risk.³

However, a similar study in Denmark showed that orchiopexy age had no effect on testicular cancer risk.⁴

Testicular cancer risks and causes The Leather Tanners - KEY POINTS Environment, genetics, and testicular cancer Established risk factors Testicular Cancer Rates

Why is cryptorchidism a risk factor for testicular cancer? Could it be because it can somehow cause testicular cancer?  Alternatively, could cryptorchidism and testicular cancer have the same cause or causes?

The answers to these questions are not yet known.  The path to the answer will likely be influenced by an interesting fact:  The increased testicular cancer risk extends to the normally descended testicle as well as to the cryptorchid testis.

A personal history of testicular cancer is a risk factor for testicular cancer. In other words, a person who develops testicular cancer is at increased risk for developing testicular cancer in the other (contralateral) testicle. Sometimes the two cancers occur simultaneously, but often the second cancer occurs later. These second cancers are primary cancers and are not due to metastasis. Men who have been treated for testicular cancer are informed of the risk to the other testicle so they can be alert to symptoms, and the other testicle is carefully evaluated during follow-up exams.

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Kathleen M. Verville, Ph.D.
Consulting Editor,

Donna Bozzone, Ph.D.,
Professor of Biology

Saint Michael’s College

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<sub>References
1. Centers for Disease Control and Prevention, “Epidemiologic and Reports Testicular Cancer in Leather Workers-Fulton County, New York,” Morbidity and Mortality Weekly Report 38, 7 (1989): 111-114.
2. S.  M.  Levin, D.  B.  Baker, P.  J.  Landrigan, S.  V.  Monaghan, E.  Frumin, M. Braithwaite, and W. Towne, “Testicular Cancer in Leather Tanners Exposed to Dimethylformamide (letter),” Lancet 2, 8568 (1987): 1153.
3. A. Petterson, L. Richiardi, A. Nordenskjold, M. Kaijser, and O. Akre, “Age of Surgery for Undescended Testis and Risk of Testicular Cancer,” The New England Journal of Medicine 356, 18 (2007): 1835-1841.
4. C.  Myrup, et al., “Correction of Cryptorchidism and Testicular Cancer (correspondence),” The New England Journal of Medicine 357 (2007): 825-827.</sub>

RELATED STORIES:
Testicular Cancer Rates vary among different groups   Environment, genetics, and testicular cancer   Testicular Cancer - The Leather Tanners

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