Testicular cancer in Canada
National Post Ontario, Canada Tue 26 Jan 1999 News A1 / Front
More men suffer testicular cancer: 'Something strange is going on': 60% increase in Ontario By: Brad Evenson
The rate of testicular cancer, often called the "young man's disease" because most get it before their 40th birthday, has risen by 60% in the past 35 years in Ontario. The statistics are similar across the country. And not only are its victims getting younger, evidence suggests the rise in testicular cancer is linked to a world wide phenomenon of shrinking testes, genital deformities, and low sperm counts. Some scientists believe the culprit could be exposure to such organic chemicals as DDT and PCBs, which disrupt the body's endocrine system. "This rise has been reported throughout the Western world, so it doesn't seem like that much of an inference to conclude that something strange is going on," said Dr. Laurence Klotz, a professor of surgery at the University of Toronto. Cancer was far from Eric Desjardins' mind three years ago as the 19-year-old rode his mountain bike to class. Suddenly, a sharp groin pain sent him lurching toward the curb. The Kitchener-born college freshman feared a sexual disease. So when his doctor told him the tender lump in his testes was caused by cancer, he was stunned. "Cancer?" he shouted. "But I'm not even 20! I don't even have a driver's licence! I'm too young to have cancer!" Mr. Desjardins' doctor told him the disease was serious, but his chances were good. A study published today in the Canadian Medical Association Journal says although testicular cancer is rising at about 2% a year in Ontario, there have been great advancements in treatment. What is more mysterious is its causes. Dr. Klotz, a leading Canadian authority on testicular cancer, said it usually begins in the foetus, when male sex organs are being formed. "The testicle is extremely sensitive to hormonal influences in utero. And if those hormonal influences are deranged even mildly, you get what's called dysgenesis, meaning you get malformation of the cells," he said. When a boy hits puberty and his testicular cells undergo rapid growth, these malformed cells can cause cancer. One reason the average age of victims is getting younger is because boys-like girls-now reach puberty earlier. In 1965, there were 69 cases of testicular cancer reported in Ontario males aged 15 to 29. In 1995, there were 215, although the study suggests an unexplained dropoff in the risk to young boys in the past five or six years. Testicular cancer is still rare in spite of the steady increase. It strikes about six in 100,000 males in Canada each year and is not usually fatal. About65% of those with metastatic disease-meaning the cancer has spread through the body-survive; about 97% of those whose cancer is isolated to the testes are cured. Overall, the survival rate is 85%. Treatment is not a trivial matter, however. It means surgical removal of a testicle, radiation, and often chemotherapy. Some patients become sterile, likeMr. Desjardins, who wonders if living in Canada's industrial heartland exposed him to chemical dangers. "If I want to have kids, obviously I'll have to adopt," said Mr. Desjardins, whose cancer had metastasized. Scientists have been concerned about the effects of so-called endocrine disruptors since the early 1980s, when Scandinavian researchers began noticing changes in male sex characteristics. For example, a Finnish study found an 11%reduction in the weight of testicles between 1981 and 1991, combined with a 27%to 57% drop in incidence of sperm production. A French group reported similar results. In 1996, Danish researchers reported that fathers of 2,000 children with testicular cancer had double the average rate of testicular cancer, and that brothers of 702 of these victims had rates 12 times higher than expected. However, while animal studies have shown environmental toxins can cause mutations in sex organs, data on humans is contradictory and scarce. "I think most people feel there is a link there but it hasn't been nailed down," said Dr. Klotz. Some researchers, for example, have suggested the sedentary Western lifestyle is causing the problem. The increase may also have to do with trends in Western society. For example, women who get pregnant at an older age tend to produce less estrogen, a hormone that influences foetal development. "It may be that we're talking about a socio-demographic shift more than an environmental cause," said Loraine Marrett, a Cancer Care Ontario researcher. For that reason, most scientists say the public should not panic. "The environmentalists are going to jump on this," predicted Dr. Klotz. "We should not, however, conclude that we are poisoning ourselves and poisoning our foetus' gonads by these chemicals. We really aren't there yet."