Changing incidence and delay of testicular cancer in southern Norway (1981-1992).

METHODS: The medical records of 352 patients with newly diagnosed testicular cancer were reviewed. Patients were orchiectomized during three 2-year periods (1981/82, 1986/87, 1991/92) and were referred for further treatment to the Norwegian Radium Hospital. They represented 96% of all cases with unilateral testicular cancer occurring within a defined area in the southern part of Norway.
RESULTS: An increase in testicular cancer patients was registered, mainly between the second and third time periods (61% increase). Gynaecomastia was recorded in 7% of all patients (seminoma: 6%; non-seminoma: 8%). Serum tumour markers (alpha-fetoprotein and/or human choriogonadotropin) were elevated before orchiectomy in 51% of the evaluated patients. During the studied 12-year period, considering seminoma and non-seminoma patients combined, the overall median delay decreased from 18 to 14 weeks (p = 0.006), the overall median diagnostic delay decreased from 14 to 10 weeks (p = 0.04) and the median treatment delay decreased from 37 to 28 days (p = 0.002). Due to increased frequency of stage I patients, introduction of an outpatient-based surveillance policy and improved administrative routines of the Health Care System, the median time of hospitalization was reduced from 37 (1981/82) to 9 days (1991/92). In seminoma, but not in non-seminoma patients, an overall delay of less than 16 weeks from the onset of symptoms was correlated with the incidence of stage I disease. The cancer-related 5-year survival rate for all 352 patients was 99%, without significant difference between the three periods under investigation. A patient's delay of more than 3 months was correlated with a significantly decreased 5-year survival rate if all patients are considered (p = 0.02).
CONCLUSION: (1) The significant increase of the incidence of testicular cancer in the southern part of Norway remains unexplained and warrants intensified search for aetiological factors of this malignancy. (2) The Health Care Service is challenged to make available sufficient resources for the rapid diagnosis, treatment and follow-up of the increasing number of new patients with testicular cancer, following modern principles of toxicity-reduced and resource-saving treatment. (3) Attempts should be made to shorten the patient's and doctor's delay by awareness campaigns and postgraduate education of general practitioners. The importance of the determination of serum tumour markers in patients with testicular masses should, in particular, be emphasized together with the significance of gynaecomastia in the young adult male.