Data published recently by Cancer Research UK has revealed that survival rates for testicular cancer have improved dramatically in the last few decades. Earlier detection allied to new therapies mean that the typical five year survival rate is increasing.
This statistic was around 70% in the nineteen seventies and had improved to around 90% twenty years ago. This improvement has been experienced across the world - in the United States the percentage survival rate is also in the high nineties. It is also worth noting that even when the cancer has spread from its initial location ( which in any event only occurs with some 5% of these cancers), treatment can still be effective and as a consequence, survival rates are increasing.
Notwithstanding these improving survival rates, and as with other forms of cancer, the incidence of the condition occuring in the first place is growing worldwide, having doubled in the last forty years. In addition, there are significant variations in the patterns of the disease which is causing concern in those areas where it is already most evident and seems to be increasing more dramatically.
In Scandanavia - Norway and Denmark in particular - rates appear to be dramatically higher than in other parts of the West. Last year, reported cases were some 12 per 100,000 men in these two countries, compared to around five in the US and the rest of Europe, and around one for the world as a whole.
Generally, rates are significantly higher among caucasians than in other ethnic groups (being five times more common in white men than black men) and in striking contrast to almost all other cancers, it is a condition affecting the young rather than older people. The age group most ' at risk' of presenting the disease are men aged between 20 and 34 and then those aged between 35 and 40.
Research into the specific causes of this cancer have suggested that there is a strong association between cryptorchidism and its eventual appearance. Cryptorchidism is the condition of 'undescended testicles' i.e - where testicles have not completed the descent from the abdomen to their ultimate location in the scrotum at birth or in the first year. This condition appears to increase the probability of eventual onset of testicular cancer by between 3 and 5 times.With regard to the anomalous incidence of testicular cancer in Scandanavia, research has also suggested a higher level of cryptorchidism in this region and work is progressing there to look for recent environmental changes that may contribute in some way to this and hence contribute to the development of the cancer in the young adult.
Self examination is seen as the most effective and practical form of screening for the disease. The suggestion is that this is best performed after a shower or bath and regularly carried out with the aim of identifying any apparent unusual features - particularly lumps or swellings on the testicles roughly the size of a pea. Such lumps and swellings are of course by no means all caused by cancer ( in fact less than 4% of such lumps turn out be cancerous) but should be checked out quickly with a doctor.
Once detected and confirmed, the treatment is straightforward - although possibly appearing dramatic as the affected testicle is typically removed. Just to be absolutely clear, the loss of one testicle does not affect either sexual performance or fertility. In the case of early detection, removal of the affected testicle may be the only treatment required at all. If there is evidence that the cancer has spread, then chemotherapy may also be prescribed.
Leaving aside the specific situation in Scandinavia, there is an sense that although testicular cancer incidence is still increasing, it appears to be a condition whereby mortality may fall even further from the levels that have been achieved over the last three or four decades. Publicity about the treatability of the condition, combined with a greater degree of openness about sexual matters, may well have increased early detection. This, taken together with the increased effectiveness of chemotherapy, have all worked together to produce postivie results.
The task of the health agencies is to maintain a sensible level of publicity about the condition to make sure that none of the ground secured so far is lost and improvements continue to occur.