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  • In this context it is noteworthy that a Dutch study


    In this context it is noteworthy that a Dutch study [34] found that incidence under-estimation mainly concerned not pathologically confirmed and elderly PC cases, whose exclusion results in survival over-estimation. Thus, although we found that survival was poor, it might even be worse for these cancers than estimated. Another study limitation is that our data go back to 2000–2007. However they are the latest data available. The current joint European Network of Cancer Registries/EUROCARE round, which is collecting data on cases diagnosed up to 2012 [9], is emphasising the importance of collecting information on stage and treatment, so forthcoming publications will probably present analyses by stage at diagnosis and treatment, allowing evaluation of treatment effectiveness and quality of care.
    Conclusions Our finding of uniformly poor survival for PC and BTC in Europe, together with increasing incidence particularly among the elderly and women, in an ageing European population [6], highlight an emerging public-health problem in relation to these cancers. Improvements in prevention, detection, and treatment are urgently required. Since 2011, European countries have been working on joint actions to reduce cancer incidence and mortality, and improve patient quality of life [35]. It is hoped that they will produce recommendations for poor-prognosis cancers like PC/BTC. In the meantime high Trichostatin A (TSA) epidemiological studies [36], that analyse outcomes in relation to biomolecular characteristics of the cancers, treatments, co-morbidities, and socioeconomic status will increase our understanding of the natural history of PC/BTC. Population-based data will remain fundamental in the foreseeable future for assessing burden and effectiveness of treatments for PC and BTC [37].
    Authors’ contributions
    Declarations of interest
    Introduction Testicular cancers are rare cancers in the general population, but are the most commonly occurring cancer among men aged 15 to 44 years in the United States [1]. The majority (approximately 98%) of testicular cancers are germ cell tumors (TGCT). TGCTs are classified into three histologic subtypes: seminomas, nonseminomas, and spermatocytic tumors. The median age of diagnosis for seminomas is 35 years and for nonseminomas 25 years while spermatocytic tumors, which are less aggressive and etiologically distinct from seminomas and nonseminomas, peak at an older age (median age 62 years). Seminomas and nonseminomas comprise the majority of germ cell tumors (approximately 56% for seminoma and 43% for nonseminoma) while spermatocytic tumors are much less common, accounting for less than 1% of the total. The small percentage of testicular cancers that are not germ cell tumors (approximately 2%) include sex cord stromal tumors, such as Leydig cell and Sertoli cell tumors, as well as other rare or poorly defined histologic subtypes. The incidence of TGCT has substantially increased in recent decades [2]. The rapid increase in incidence suggests that critical changes in environmental factors may contribute to the development of TGCT [3]. To date, there are few studies focusing on testicular cancer in men aged ≥ 50 years [4,5]. Thus, the aim of overkill study was to provide detailed descriptive features, including age patterns and incidence rates of TGCT among men aged ≥ 50 years. In addition to TGCT, we were also interested in other tumors that arise in the testes, such as primary testicular lymphoma; predominantly a disease of men ≥ 50 years and often disregarded in population-based studies.
    Methods Primary malignant testicular cancers were identified from the Cancer Incidence in North America (CiNA) analytic file provided by the North American Association of Central Cancer Registries (NAACCR). Cancer incidence data that meet high-quality standards from the SEER program and the Centers for Disease Control and Prevention’s National Program of Cancer Registries are included in the CiNA analytic data set [6]. Data from forty-one registries were included for the years 1999 through 2014. These registries included Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming (approximately 90% coverage of the US population). The CiNA analytic file dates back to 1995, but due to missing data from many of the registries, we restricted all analyses to the year 1999 forward.