Testicular cancer is generally curable if appropriate treatment is given. Data and statistics on testicular cancer mortality over the last decades are available from the US and Canada, but are more difficult to find, in a standard and comparable format, for Central and South American countries. The objective of the study was to compare death rates and trends over the 1980–2003 period in all the American countries that provide data.
Overall and 20 to 44 years age-standardized (world population) mortality rates from testicular cancer, derived from the World Health Organization (WHO) database, are presented for the most recent available calendar years in 10 American countries. Trends in mortality for selected countries of the Americas are also given over the period 1980–2003.
In the early 1980s the highest testicular cancer mortality rates were observed in Chile (1.7/100,000 at all ages, 3.6/100,000 at 20–44 years) and Argentina (0.9/100,000 at all ages, 1.7/100,000 at 20–44 years), as compared with 0.4/100,000 for all ages and 0.6/100,000 at 20 to 44 years in Canada, and 0.3/100,000 for all ages and 0.7/100,000 at 20 to 44 years in the US. In 2001–2003, testicular cancer mortality had fallen to 0.2/100,000 in men aged 20 to 44 years in Canada, and to 0.4/100,000 in the US. Conversely, rates were still 1.6/100,000 in Argentina, 2.2/100,000 in Chile and 1.2/100,000 in Mexico, and were around 0.5–0.6/100,000 in most other Latin American countries that provide data.
Testicular cancer, particularly seminomas and teratomas in young men, is 1 of the most curable neoplasms if adequate treatment is adopted.1–7 In Europe substantial differences in mortality from this neoplasm were found between western and eastern European countries, probably due to different availability of the expensive drugs required to treat testicular cancer.8–10 Although it is known that mortality from testicular cancer substantially declined in North America, data for Latin America are scant.11–13
In the present work we report recent trends from testicular cancer mortality for Latin American countries where data were available and, for comparative purposes, the US and Canada.
MATERIALS AND METHODS
Certified deaths from testicular cancer were derived from the World Health Organization (WHO) database14 for 8 Latin American countries with available mortality and population data, ie, Argentina, Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Venezuela, plus Canada and the US.
During the calendar period considered (1980–2003), 2 different revisions of the International Classification of Diseases (ICD) were used.15, 16 Classification of cancer deaths was thus recoded for all periods according to the Ninth Revision of the ICD15 (ICD IX code, 186).
Estimates of the resident populations, based on official censuses, were obtained from the same WHO database14 or from the Pan American Health Organization (PAHO)17 when WHO data were unavailable. Because the PAHO database only provided data for broad age groups (<1, 1–4, 5–14, 15–44, 45–64, 65+ years), quinquennia of age were estimated by interpolating from the population of the last year available from the WHO.
Overall and 20 to 44 years age-standardized rates per 100,000 men were computed using the direct method on the basis of the world standard population.18
In order to obtain more stable rate estimates, when the number of deaths was too small (<50) or rates were too unstable, the rate was computed considering at most 3 years around 1982 and 2002 (except for Canada and the US, for which 5 years around 1982 were considered).
Trends in mortality were reported for those countries presenting data from the early 1980s to years around 2002 (ie, Argentina, Chile, Canada, the US).
Table 1 includes the average number of deaths per year and the age-standardized mortality rates from testicular cancer per 100,000 men for all ages and the 20 to 44 years age group. In the early 1980s the highest mortality rates were in Chile (1.7/100,000 for all ages, 3.6/100,000 for 20–44 years) and Argentina (0.9/100,000 for all ages, 1.7/100,000 for 20–44 years), as compared with 0.4/100,000 for all ages and 0.6/100,000 at 20 to 44 years in Canada, and 0.3/100,000 for all ages and 0.7/100,000 at 20 to 44 years in the US. In 2001–2003 the highest testicular cancer age-standardized mortality rates for men of all ages were again in Chile (1.2/100,000) and Argentina (0.8/100,000), whereas the corresponding values were 0.2/100,000 for both the US and Canada.
Table 1. Average Certified Number of Deaths Per Year and Age-Standardized (World Population) Testicular Cancer Rates Per 100,000 Men, for All Ages and at Age 20–44 Years
Years used to calculate rates: in order to obtain more stable rate estimates, when the number of deaths was too small (<50) or rates were too unstable, the rate was computed considering at most 3 years around 1982 and 2002 (except for Canada and the US): Argentina [1980–81]/[2001–03], Chile /, Colombia , Costa Rica [2000–02], Cuba [2001–03], Ecuador [2001–03], Mexico , Venezuela [2000–02], Canada [1980–84]/, US [1980–84]/.
Data unavailable for the whole quinquennium 1980–1984.
Figure 1 gives the age-standardized death rates from testicular cancer for the 20 to 44 years age group in the most recent calendar years available for each country. The highest rates were in Chile (2.4/100,000) and Argentina (1.6/100,000). In Cuba, the testicular cancer mortality rate was similar to that of North American countries (0.3/100,000).
Figure 2 shows trends in mortality for testicular cancer at 20 to 44 years for the available 5-year calendar periods from 1980–1984 to 1995–1999 and around the year 2002, except for Argentina, for which the period 2001–2003 was considered. Between the early 1980s and the early 2000s, mortality from testicular cancer in young men steadily decreased in Chile (−38%), Canada (−64%), and the US (−36%). Mortality was almost stable in Argentina over the same period (−2%).
This is essentially a descriptive report and no inference is made on the statistical significance of rates and trends. Still, in order to give a critical interpretation of these results, problems related to random variation, which are greater in smaller populations, have to be considered. This applies mainly to Cuba, Costa Rica, and Ecuador. Death certification reliability and validity may also differ across various countries.19–21
Nevertheless, there are 2 aspects indicating that death certification data on testicular cancer are acceptably valid. First, the testicle is a visible and palpable organ, hence diagnosis of testicular cancer is easy even in the absence of sophisticated instruments.7, 22 Second, the young age of most patients with testicular cancer is known to be associated with greater reliability and validity of cancer death certification diagnoses.23 Thus, misclassification and underregistration for testicular cancer death is less of an issue than for most other malignancies, even in middle-income and developing countries.22 Furthermore, in 2002 the estimated testicular cancer incidence at all ages in Argentina, the most populous South American country considered, was 4.2/100,000, ie, comparable with data from the US and Canada (5.5/100,000 in the US, 4.6/100,000 in Canada).24
Even if national mortality data cannot directly address issues of interpretation, and in particular access to health care, the fall in testicular cancer mortality has not been satisfactory in all American countries. Indeed, in 2000–2002 a 6- to 8-fold difference in testicular cancer mortality in young men was still observed between Canada, the US (and Cuba), and Chile. As previously noted for the excess testicular cancer mortality in Central and Eastern Europe as compared with Western Europe,8–10 discrepancies in testicular cancer mortality between Latin and North American countries essentially reflect an inadequate adoption of modern platinum-based chemotherapy regimens, which have substantially reduced mortality from testicular cancer in developed areas of the world since the early 1970s.6, 10 The poor availability of mortality data from testicular tumors in middle-income and developing countries of the Americas (including the absence of valid data for the largest country, Brazil) may reflect a lack of attention toward the management and treatment of this important aspect of male health.
The results of this systematic analysis of death rates from testicular cancer in the Americas support observations made for childhood cancers25: where disease control depends on technological advances in medical care, the US and Canada benefit from an earlier and more effective introduction of new therapeutic approaches. Education of both the public and health professionals, with respect to investigation of testicular abnormalities, may also be important.
A major effort focusing on this issue should be made by local and international institutions in order to better support these countries in developing and enhancing their knowledge, data collection capabilities, and management of testicular cancer.
We thank Mrs I. Garimoldi for editorial assistance