Abstract
Though the etiology is largely unknown, testicular cancer incidence has seen recent significant increases in northern Europe and throughout many Western regions. The most common cancer in males under age 40, age period cohort models have posited exposures in the in utero environment or in early childhood as possible causes of increased risk of testicular cancer. Some of these factors may be tied to geography through being associated with behavioral, cultural, sociodemographic or built environment characteristics. If so, this could result in detectable geographic clusters of cases that could lead to hypotheses regarding environmental targets for intervention. Given a latency period between exposure to an environmental carcinogen and testicular cancer diagnosis, mobility histories are beneficial for spatial cluster analyses. Nearest-neighbor based Q-statistics allow for the incorporation of changes in residency in spatial disease cluster detection. Using these methods, a space-time cluster analysis was conducted on a population-wide case-control population selected from the Danish Cancer Registry with mobility histories since 1971 extracted from the Danish Civil Registration System. Cases (N=3297) were diagnosed between 1991 and 2003, and two sets of controls (N=3297 for each set) matched on sex and date of birth were included in the study. We also examined spatial patterns in maternal residential history for those cases and controls born in 1971 or later (N= 589 case-control pairs). Several small clusters were detected when aligning individuals by year prior to diagnosis, age at diagnosis and calendar year of diagnosis. However, the largest of these clusters contained only 2 statistically significant individuals at their center, and were not replicated in SaTScan spatial-only analyses which are less susceptible to multiple testing bias. We found little evidence of local clusters in residential histories of testicular cancer cases in this Danish population.
Highlights
Testicular cancer incidence in Western countries dramatically increased from the 1940’s to the 1990’s, and has become the number one cause of cancer in males under age 40 [1]
In the conditional logistic regression analyses, the only variable that was a statistically significant predictor for both seminomas and all cases using both control groups was that of having a family history of testicular cancer [23]
This study used a complete record of all residential histories in Denmark to investigate local clusters of testicular cancer among residents from 1971 until diagnosis in 1991–2003
Summary
Testicular cancer incidence in Western countries dramatically increased from the 1940’s to the 1990’s, and has become the number one cause of cancer in males under age 40 [1]. From 1943 to 2003 the incidence rates in Denmark increased from 3.4 to 10 cases per 100,000 person-years; its rates are among the highest in the world [3,5]. In recent years, these rates appear to be stabilizing [6]. Despite many potential risk factors that have been examined, the only firm determinants of testicular cancer risk remain age, family history of testicular cancer, national origin, birth year, ethnicity, and cryptochoridism (undescended testes) which is found in 10% of all cases [4,7,8,9,10,11]. There is a latency period between exposure to carcinogens and disease manifestation, which should be taken into account when conducting an epidemiologic analysis of testicular cancer
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