Curable Cancer

By Ian Smith, M.D.

Until survivor Lance Armstrong triumphed in this summer's Tour de France bicycle race, testicular cancer didn't get a lot of press. One likely reason is that men hate to think about a malignancy in that vital and exceedingly sensitive part of the body. The treatment--surgical removal of the testicle--is even worse to contemplate. But another reason is that testicular cancer is relatively rare: only 7,400 cases will be diagnosed in the U.S. next year, representing 1% of new male cancers. Prostate cancer is 30 times as common.

Although testicular cancer is fairly easy to treat, as cancers go, it is on the rise. An article in the August Journal of Urology reports that the incidence of the disease has shot up 51% over the past 40 years. And while it's typically diagnosed between ages 30 and 35, with a second, smaller peak in men over 65, testicular cancer is now showing up in younger and younger men. Despite its low profile, in fact it's the most prevalent form of cancer among men in their 20s and 30s.

Nobody knows why this is happening, but researchers think that identifying risk factors may help solve the mystery. Genetics clearly plays a role: in the Journal study, more than 11,000 of the U.S. cases cited involved white men, while fewer than 650 victims were nonwhites. International data tell the same story: Northern Europeans are particularly vulnerable, and Scandinavians have the highest rate in the world.

Beyond that, says Dr. Lawrence Einhorn of Indiana University, who treated Lance Armstrong, "we have looked at several risk factors, and the only one that's really been proved is cryptorchidism." In plain English, that means undescended testicles. In a male fetus, the testicles normally develop inside the abdomen and descend into the scrotal sac before birth. In some cases, though, one (and sometimes both) of the testicles stays inside the body. The laggard normally drops into place in the child's first year of life, though surgery is sometimes needed to help it along.

But while most undescended testicles eventually get where they're supposed to be, the delay seems to cause some sort of damage: cryptorchidism affects only 3% of the male population but is a factor in 14% of testicular-cancer cases. Doctors have identified other risk factors, such as a family history of testicular cancer, HIV infection and a previous bout with the disease. But none of these explain the dramatic rise in incidence. Other possible risks include occupational exposure to extreme temperatures and the maternal use of fertility hormones.

The good news, meanwhile, is that testicular cancer is one of the least deadly of malignancies: if you include the most advanced stages of disease, it has a five-year survival rate of 95%--and for cases detected early, the rate is 100%. For that reason, many experts suggest that men (of all races) should perform self-examinations monthly, starting at age 15. The best time to do this is after a warm shower, when the scrotum is relaxed and soft. The danger signs include a hard, painless lump attached to the testicles or, less commonly, testicular enlargement or scrotal swelling. Probing their testicles, even gently, may not be high on most men's list of appealing ideas. But given the potential payoff, they should do it anyway.

For more information on testicular cancer, see our website at time.com/personal You can e-mail Ian at ianmedical@aol.com