Testicular cancer survivors at risk of dying from non-cancer causes

Men who have survived for at least 1 year after being diagnosed with testicular cancer have a slightly higher risk of dying from non-cancer causes-including infections, digestive diseases, and circulatory diseases-than the general population does, a study published in the Journal of the National Cancer Institute (2007; 99:533-44) suggests. Men treated with chemotherapy in 1975 or later may be at particularly high risk.

The multicenter study, led by Sophie D. Fosså, VMD, PhD, of the University of Oslo, Norway, identified 38,907 1-year survivors of testicular cancer within 14 population-based cancer registries in North America and Europe (from 1943 through 2002). The team used data from these registries to calculate standardized mortality ratios (SMR) for non-cancer deaths and to evaluate associations between histology, age at diagnosis, calendar year of diagnosis, and initial treatment and the risk of non-cancer mortality.

A total of 2,942 deaths from all non-cancer causes were reported after a median follow-up of 10 years, exceeding the expected number of deaths from all non-cancer causes in the general population by 6%; the non-cancer standardized mortality ratios did not differ significantly between patients diagnosed before and after 1975, when cisplatin-based chemotherapy came into widespread use.

Compared with the general population, testicular cancer survivors had higher mortality from infections (SMR=1.28, 95% CI=1.12 to 1.47) and from digestive diseases (SMR=1.44, 95% CI=1.26 to 1.64). Mortality from all circulatory diseases was statistically significantly elevated in men diagnosed with testicular cancer before age 35 years but not in men diagnosed at older ages.

Men treated with chemotherapy in 1975 or later had higher mortality from all non-cancer causes (SMR=1.34, 95% CI=1.15 to 1.55), all circulatory diseases (SMR=1.58, 95% CI=1.25 to 2.01), all infections (SMR=2.48, 95% CI=1.70 to 3.50), and all respiratory diseases (SMR=2.53, 95% CI=1.26 to 4.53). Testicular cancer patients who were younger than 35 years at diagnosis and were treated with radiotherapy alone in 1975 or later had higher mortality from all circulatory diseases (SMR=1.70, 95% CI=1.21 to 2.31) compared with the general population.