Men Who Develop Testicular Cancer Have Fertility Problems Even Before Diagnosis, UB Epidemiologists Find

SEATTLE -- Men who develop testicular cancer father fewer children and are more likely to have been diagnosed with infertility prior to their cancer diagnosis than healthy controls, a University at Buffalo study has found.

The research results, presented here today (June 12, 2000) at the annual meeting of the Society for Epidemiologic Research, contradict earlier findings that showed no relationship between a man's fertility and an eventual diagnosis of testicular cancer.

In this current study, men with an eventual diagnosis of testicular cancer were found to be two-thirds less likely to have ever fathered a live infant, and to be nine times more likely to have been diagnosed as infertile than healthy men.

Julie Baker, a doctoral student in the UB Department of Social and Preventive Medicine and lead author on both studies, said the new results reflect a larger number of cases from a state-wide, rather than regional, database. The previous study was done at Roswell Park Cancer Institute (RPCI) in Buffalo, a regional cancer center that treats some of the area's sickest patients and may not represent the experiences of men with less-aggressive cancers or men in the general population, she said. The current study involved cancer cases identified through the New York State Cancer Registry.

It also used healthy men as controls, while the previous study used men who had other types of non-hormonal cancers. "We had no reason to believe that fertility would be affected in men with non-hormonal cancers," Baker said, "and we didn't see a difference between the two groups of men. There is always the possibility that both groups of men are impaired in the same way, probably either because of the pathology of their diseases or something about men that end up being treated at RPCI. However, we don't know enough about how fertility relates to subsequent cancer to be able to explain why the groups were so similar.

"In the current study, all men in Upstate New York who were diagnosed with testicular cancer over a three-year period were eligible for the study, so the men we interviewed probably are more representative of men with this diagnosis. Also, the use of healthy neighborhood controls may make the experiences of the comparison group more similar to those of men in the general population. Together, this should give us a better picture of whether the groups have similar fertility histories."

Testicular cancer is rare in the United States, accounting for only 1 percent of cancers in males. However, it is the most common cancer of young white men between the ages of 20 and 34, and the second-most common among men 15-19 and 35-39 years old, according to National Institutes of Health statistics. Lance Armstrong, who won the Tour de France in 1999 after surviving testicular cancer that had spread to his lungs and brain, brought the disease into the public arena recently with his story of recovery and victory.

Baker's study involved 201 cancer patients and 204 healthy controls matched on age and neighborhood of residence. Analyzing medical, dietary, occupational, demographic and reproductive information from both groups, Baker found that men with testicular cancer were less likely to have fathered a live-born infant, and had significantly fewer offspring than the healthy men. This result held when the analysis was restricted to only men who had attempted to impregnate a partner.

Men with testicular cancer also were significantly more likely to have had an infertility diagnosis or low-sperm count prior to developing cancer.

Cancer of this type is strongly associated with a condition called cryptorchidism, or undescended testes at birth, Baker noted, and researchers suspect that the development of this cancer is related to events that occur in the womb.

"We had been thinking that these men were normal until they developed tumors and then they got sick," she said. "Now we think they have been sick all along. The next step is to backtrack to find the causal agent."

Also participating in this research were Germaine M. Buck, Ph.D.; John M. Weiner, Ph.D., and John E. Vena, Ph.D., all of the UB Department of Social and Preventive Medicine, and Kirsten B. Moysich, Ph.D., of Roswell Park Cancer Institute.