Testicular cancer patterns in African-American men

Abstract

Objectives To compare the testicular cancer incidence, pathologic grade, stage, and survival between African Americans and whites. African Americans had a worse outcome relative to whites with regard to a number of different malignancies. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted all testicular cancer cases among white and African-American males for 1985 to 2000. Baseline demographic data included age at diagnosis, year of diagnosis, stage at diagnosis, and histologic type. Survival was examined using the Kaplan-Meier method and Cox proportional hazards modeling. Results The incidence of testicular cancer among African Americans was one fourth that observed among whites. However, African-Americans presented with a higher disease stage at diagnosis. African Americans also presented with significantly lower proportions of embryonal cell carcinoma. Overall survival among African-Americans was significantly worse at both 5 and 10 years. When overall survival was adjusted for stage at presentation and histologic type, the observed survival differences disappeared. Conclusions African Americans appear to present with a higher disease stage than do whites. Observed differences in survival for the African-American group relative to whites appear to be primarily due to delayed presentation. Cultural perceptions of malignancy and understanding of cancer screening may be an important determinant of later presentation. Healthcare access and education issues, rather than inherent biologic differences, appear to be the primary underlying factor for the observed survival differences in African-American males.