What are the risk factors for testicular cancer?

A risk factor is anything that changes your chance of getting a disease such as cancer.  Different cancers have different risk factors.  For example, exposing skin to strong sunlight has a higher risk factor for skin cancer than not a lot of exposure.  Smoking has a higher risk factor for many cancers.  But having a risk factor, or even several, doesn’t mean that you will get the disease.  Just as having no risk factors doesn’t mean you won’t get the disease.

Scientists have found few risk factors that make a man more likely to develop testicular cancer.  Even if a man has one or more risk factors for this disease, it is impossible to know for sure how much that risk factor contributes to developing the cancer.  Also, most men with testicular cancer do not have any of the known risk factors.

Undescended testicle

One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This means that one or both testicles fail to move into the scrotum before birth. Males with cryptorchidism are several times more likely to get testicular cancer than those with normally descended testicles.

Normally, the testicles develop inside the abdomen of the fetus and they go down (descend) into the scrotum before birth. In about 3% of boys, however, the testicles do not make it all the way down before the child is born. Sometimes the testicle remains in the abdomen. In other cases, the testicle starts to descend but remains stuck in the groin area.

Most of the time, undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle has not descended by the time a child is a year old, it probably won’t go down on its own. Sometimes a surgical procedure known as orchiopexy is needed to bring the testicle down into the scrotum.

The risk of testicular cancer may be somewhat higher for men whose testicle stayed in the abdomen as opposed to one that has descended at least partway. Most cancers develop in the undescended testicle, but about 1 out of 4 cases occur in the normally descended testicle. Based on these observations, some doctors conclude that cryptorchidism doesn’t actually cause testicular cancer but that there is something else that leads to both testicular cancer and abnormal positioning of one or both testicles.

Orchiopexy done when a child is younger may be more likely to reduce the risk of testicular cancer than surgery that is done when the child is older. But the best time to do this surgery is not clear. Experts in the United States recommend that orchiopexy be done soon after the child’s first birthday for reasons (such as fertility) that are not related to cancer.

Family history

A family history of testicular cancer increases the risk. If a man has the disease, there is an increased risk that one or more of his brothers or sons will also develop it. But only about 3% of testicular cancer cases are actually found to occur in families. Most men with testicular cancer do not have a family history of the disease.

Carcinoma in situ

This condition, does not produce a mass or cause any symptoms. It isn’t clear how often carcinoma in situ (CIS) in the testicles progresses to cancer. In some cases, CIS is found in men who have a testicular biopsy to evaluate infertility or have a testicle removed because of cryptorchidism. Doctors in Europe are more likely than the doctors in the USA to look for CIS. This may be why the figures for diagnosis and progression of CIS to cancer are lower in the United States than in parts of Europe. Since we don’t know how often CIS becomes true (invasive) cancer, it isn’t clear that treating CIS is a good idea. Some experts think that it may be better to wait and see if the disease gets worse or becomes a true cancer. This could allow many men with CIS to avoid the risks and side effects of treatment. Radiation or surgery (to remove the testicle) is used to treat CIS.

Cancer of the other testicle

A personal history of testicular cancer is another risk factor. About 3% or 4% of men who have been cured of cancer in one testicle will eventually develop cancer in the other testicle.

Age

About 9 out of 10 testicular cancers occur in men between the ages of 20 and 54. But this cancer can affect males of any age, including infants and elderly men. Although we do know that you are at more risk from the ages between 15-35.

Race and ethnicity

The risk of testicular cancer among white men is about 5 times that of black men and more than 3 times that of Asian-American and American Indian men. The risk for Hispanics/Latinos falls between that of Asians and non-Hispanic/Latino whites. The reason for these differences is not known. Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among men living in Africa or Asia.

Body size

Some studies have found that the risk of testicular cancer is somewhat higher in tall men, but other studies have not.

Unproven or controversial risk factors

Prior trauma to the testicles and recurrent actions such as horseback riding do not appear to be related to the development of testicular cancer.

Most studies have not found that strenuous physical activity increases testicular cancer risk. Being physically active has been linked with a lower risk of several other forms of cancer as well as a lower risk of many other health problems.

 

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