September 21, 2005

Testicular Cancer Survivors at Risk of Other Cancer

NEW YORK -- Men like cyclist Lance Armstrong and comedian Tom Green who survived testicular cancer are at increased risk of developing other types of cancer for at least 35 years after being diagnosed with the original disease, a new analysis shows.

The study also showed for the first time a greater risk of malignant mesothelioma, a cancer affecting the lining of the lungs, and esophagus cancer among testicular cancer survivors, likely due to the outdated practice of treating these patients with chest radiation, Dr. Lois B. Travis of the National Cancer Institute told Reuters Health.

"Although chest radiation was discontinued in the 1970s, we're still seeing the late effects from this approach," Travis explained.

"We did the study because although (new) cancers are a leading cause of death among men with testicular cancer, few studies have been able to quantify the risk among very long term survivors."

To investigate, Travis and her team looked at data from population-based registries in North America and Europe that included 40,576 men who had survived at least one year after a diagnosis of testicular cancer. From 1 to 35 years after the first diagnosis, 2,285 new cancers developed among the men. The findings are published in the Journal of the National Cancer Institute.

Ten-year survivors' risk of a new cancer was nearly double that of the general population, and this risk remained high for at least 35 years. "It's the treatment effects, especially radiation, that seem to be the major determinant of the excess risk," Travis said.

Increased risk also was seen with chemotherapy use, although the data did not specify the type of treatment used or the dosage. "We think it will be important to do analytic studies to quantify the risk for specific...tumors, taking into account drug names and amounts along with radiation dose," Travis said.

Lung, colon, bladder, pancreas and stomach cancer made up nearly 60 percent of the excess cancers seen in men who had survived testicular cancer.

The good news is that testicular cancer patients treated today will likely face a much smaller risk of new cancers, Travis said, given modifications in treatment that have allowed for the reduction of radiation dosages. But the findings, she added, should alert patients and doctors to the increased risk faced by all survivors of the disease.

"Testicular cancer survivors should be encouraged to adopt practices that are consistent with a healthy lifestyle, including smoking cessation in particular because of the increased risk of lung cancer that we observed; to seek medical consultation for any persistent changes in health status; and to follow screening guidelines applicable to the general population," she concluded.

SOURCE: Journal of the National Cancer Institute, September 21, 2005.