Testicular Cancer: The Data Behind the Disease
April is Testicular Cancer Awareness Month, and it provides the perfect chance to remind practitioners and their patients about how easy this cancer can be to stop.
Testicular cancer is the 24th most common cancer in the United States and, if detected early, it has above a 99 percent survivability rate. Presently, testicular cancer represents 0.5 percent of all new cancer cases, and the prevalence of cases is on the rise, meaning more men and boys will be diagnosed each year.
Thankfully, the majority of patients will not see testicular cancer as a death sentence. To keep it that way, primary care providers (PCPs), oncologists and other doctors should take a look at the data behind the disease and understand the kinds of challenges patients face or remain unaware of today.
State of Testicular Cancer in the United States
During their lifetime, roughly 0.4 percent of men — or about 1 in 250 — will be diagnosed with the disease. The average age of diagnosis is around 33 years old, though the cancer can occur at any age. Some 6 percent of patients are diagnosed during adolescence, and 8 percent of cases are diagnosed in men age 55 or older.
“Although testicular cancer occurs most commonly in men in their 30s, providers should be aware that testicular cancer occurs in younger men as well as older men,” says Dr. Jonathan Stegall, medical director at The Center for Advanced Medicine. “Having an appropriate index of suspicion is important, as testicular cancer tends to be a very curable cancer when detected and treated appropriately.”
Dr. Stegall also provided trends and risk factors for providers and health systems to be aware of:
- Caucasian men are five times as likely as African American men to develop testicular cancer, and three times as likely as Asian American men.
- Testicular cancer is more likely in men with a history of cryptorchidism (undescended testicle).
- Men with a family history of testicular cancer are at a slightly increased risk of developing testicular cancer.
Data point to a continued rise in the number of new cases diagnosed annually for the past 40 years. However, the medical community does not have a clear consensus on the cause. The good news for patients is that the rate of increase in these cases has slowed down in recent years and death rates are on the decline, albeit slowly, based on data from 1990 to 2014.
Survival of U.S. Patients
Relying on the same dataset from the National Cancer Institute, roughly 400 to 410 people are expected to die from testicular cancer in 2019. Testicular cancer deaths often occur when cancer spreads from the testicles to other parts of the body and cannot be effectively treated with chemotherapy, radiation or surgery. Some deaths are also related to complications of treatment regimens.
In U.S. patients overall, the five-year survival rate is 95.3 percent. The sooner the cancer is detected, the higher the likelihood that the patient will survive.
If the cancer is found in a localized stage, or Stage 1, there is a 99.2 percent survival rate. If cancer has spread regionally, to the retroperitoneal lymph nodes, patients still have a roughly 96 percent survival rate. If cancer has spread outside of the testicles and nearby lymph nodes, the survival rate is 73.7 percent.
“For patients receiving a new diagnosis of testicular cancer, I would tell them that a majority of the cancers are extremely responsive to the treatments we have at our disposal,” says Dr. Anika Ackerman, a urologist at Garden State Urology. “Sometimes removal of the cancer with orchiectomy is all that is needed for cure.”
Dr. Ackerman notes that the pathology of the tumor removed, including what “stage” it is in, dictates what treatment options are ultimately available. However, many are proven successful in different applications.
The Role of the Physician Is to Help
The oncologists and doctors we spoke to all emphasized the role of the care provider to take an active approach to the disease in their practices. Patients are not always aware of what to look for, or even when they should begin checking for potential signs of testicular cancer.
Having a dialogue early and often is one of the best prevention tips for any individual, and it doesn’t matter if the patient or the provider starts the conversation.
“It can be hard to motivate patients who aren’t invested in their health,” says Dr. Oreoluwa Ogunyemi. “I believe it requires time, encouragement and a trusting relationship with the PCP. Additionally, offering to have another patient with a similar condition speak to them is a great motivator because some patients may not feel comfortable asking their physician these questions.”
Dr. Jack Goldberg, former Chief of Hematology and Medical Oncology at Penn Presbyterian Medical Center and lead medical underwriter at Fifth Season Financial, also says that help requires an understanding of where the patient is in their life. Not only can cancer be a scary diagnosis, but it can be financially challenging as well.
“From the initial diagnosis to end-of-life or survivorship, the patient/doctor relationship focuses on disease management and the treatment’s impact on quality of life as well as life expectancy. Oncologists are trained to understand and manage the disease and the available medicines to treat patients,” says Dr. Goldberg. “Unfortunately, financial toxicity — ‘the financial burden resulting from a cancer diagnosis and/or treatment’ — has also become an integral part of cancer management.”
The American Society of Clinical Oncology’s 2018 Quality Care study found that, for patients struggling financially, cost issues were raised only roughly half the time by their oncologists.
Having the conversation early and led by oncologists can make it easier for patients to learn about all of their treatment and payment options. This may include nonprofit sources, from access to care and co-pay assistance to help with medications and pro bono financial guidance. It can also ensure that oncologists pick the treatments best for patients based on medical evidence, and then give the patient enough time to discover multiple ways to afford those treatments.
Maintain Attention in 2019
The biggest danger in testicular cancer may be a lack of knowledge or a lack of understanding of the need for self-examination.
“We believe that testicular cancer awareness is often discounted due to the survival rates and treatment statistics of the disease,” says Connor O’Leary, testicular cancer survivor and chief mission officer at the Testicular Cancer Foundation. “We are still losing one male every day from the disease. The importance of early detection not only increases survival statistics, but it can eliminate unnecessary treatments (chemo, radiation, additional surgeries) that can have extremely adverse side effects. We need to ensure men know and understand the warning signs of the disease and act on any changes with their body that they see or feel.”
Understanding and early detection depend on the patient, but there is a clear role for the provider, too.