Delay in diagnosis and survival in testicular cancer: impact of effective therapy and changes during 18 years.

In an effort to determine the impact of a delayed diagnosis in testicular cancer the records of 148 patients with a known interval of delay were reviewed. The over-all mean symptomatic interval of this population was 21.1 weeks and did not change significantly during an 18-year review period. An increased symptomatic interval correlated with an increased presenting stage of disease for nonseminoma and a delay of greater than 16 weeks strongly (p equals 0.002) lowered survival for these patients during the study interval. However, the symptomatic interval was not significantly associated with stage for seminoma patients nor did the symptomatic interval influence survival for these patients. Further analysis of the nonseminoma patients revealed that delay strongly affected survival (p equals 0.001) in the pre-cisplatin era (1970 to 1978) but it was less pronounced (p equals 0.262) in the cisplatin era (1979 to 1987). Despite an attenuation of the effect of delay in the current era of effective chemotherapy, deaths still occur due to delay in diagnosis and programs to lessen delay, such as testicular self-examination, and patient and physician education, are strongly encouraged.