Testicular cancer mortality in Eastern Europe

A substantial delay in the decline of mortality from testicular cancer has been reported over the last few years. In the European Union (EU) testicular cancer rates at age 20 to 44 have fallen by 2 thirds between 1975–1979 and 1995–1997, from 1.5 to 0.5/100,000 men. However, in eastern European countries providing comparable data over time (i.e, Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia), rates have only moderately declined and were still 1.3/100,000 men age 20 to 44 in 1995–1997. This corresponded to a few hundred excess avoidable deaths per year.1 Consequently, it is important to further monitor trends in testicular cancer mortality in the last few years. As in previous reports, we obtained official death certification figures from the WHO database, and recoded them according to the Ninth Revision of the International Classification of Diseases.2 We obtained estimates of the resident population from the same WHO database. Age-standardized rates were based on the world standard population. Figure 1 shows updated trends in mortality from testicular cancer in 4 broad geographic areas. In eastern Europe, a 16% fall in males was observed between 1995–1997 and 1998–1999, from 1.30 to 1.09/100,000. The fall was 14% in the EU, from 0.51 to 0.44/100,000. In contrast, a plateau was observed in the USA and Japan, with rates in the late 1990s of 0.47/100,000 and 0.38/100,000, respectively. Overall age-standardized rates in 1995–1997 and 1998–1999 were 0.31 and 0.27/100,000 in the EU, 0.75 and 0.65/100,000 in eastern Europe, 0.21 and 0.24/100,000 in the USA and 0.14 and 0.18/100,000 in Japan. Trends in age-adjusted (world population) death certification rates from testicular cancer in men aged 20–44 years. Eastern European countries represented are Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia. There are 2 main messages in this updated analysis of trends in testicular cancer mortality. First, the levelling of the falls in rates over the last few years in the USA and Japan are confirmed by the most recent data, and testicular cancer mortality seems to have reached a plateau. Some fall is still observed in the EU, whose rates of 0.44/100,000, however, have now approached the low levels of the USA and Japan. Second, the fall registered since the early 1990s3 is persisting in eastern Europe, whose rates remain twice that of the EU and comparable to that registered in the EU in the early 1980s. In absolute terms, this corresponds to over 100 excess deaths in young men per year in the 6 countries considered. Testicular cancer, particularly seminomas and teratomas of young men, is a largely curable disease if adequate treatment is adopted.4 Thus, despite favorable trends over the last decade, there remains a substantial scope for improving testicular cancer management and treatment in eastern Europe. Fabio Levi*, Franca Lucchini*, Peter Boyle , Eva Negri , Carlo La Vecchia1* ?, * Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland, Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy, Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milano, Italy, ? Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milano, Italy.