CHANGING INCIDENCE AND DELAY OF TESTICULAR CANCER IN SOUTHERN NORWAY (1981-1992)

Methods: The medical records of 352 patients with newly diagnosed test icular cancer were reviewed. Patients were orchiectomized during three 2-year periods (1981/82, 1986/87, 1991/92) and were referred for furt her treatment to the Norwegian Radium Hospital. They represented 96% o f all cases with unilateral testicular cancer occurring within a defin ed area in the southern part of Norway. Results: An increase in testic ular cancer patients was registered, mainly between the second and thi rd time periods (61% increase). Gynaecomastia was recorded in 7% of al l patients (seminoma: 6%; non-seminoma: 8%). Serum tumour markers (alp ha-fetoprotein and/or human choriogonadotropin) were elevated before o rchiectomy in 51 % of the evaluated patients. During the studied 12-ye ar period, considering seminoma and non-seminoma patients combined, th e overall median delay decreased from 18 to 14 weeks (p = 0.006), the overall median diagnostic delay decreased from 14 to 10 weeks (p = 0.0 4) and the median treatment delay decreased from 37 to 28 days (p = 0. 002). Due to increased frequency of stage I patients, introduction of an outpatient-based surveillance policy and improved administrative ro utines of the Health Care System, the median time of hospitalization w as reduced from 37 (1981/82) to 9 days (1991/92). In seminoma, but not in non-seminoma patients, an overall delay of less than 16 weeks from the onset of symptoms was correlated with the incidence of stage I di sease. The cancer-related 5-year survival rate for all 352 patients wa s 99%, without significant difference between the three periods under investigation. A patient's delay of more than 3 months was correlated with a significantly decreased 5-year survival rate if all patients ar e considered (p = 0.02). Conclusion: (1) The significant increase of t he incidence of testicular cancer in the southern part of Norway remai ns unexplained and warrants intensified search for aetiological factor s of this malignancy. (2) The Health Care Service is challenged to mak e available sufficient resources for the rapid diagnosis, treatment an d follow-up of the increasing number of new patients with testicular c ancer, following modern principles of toxicity-reduced and resource-sa ving treatment. (3) Attempts should be made to shorten the patient's a nd doctor's delay by awareness campaigns and postgraduate education of general practitioners. The importance of the determination of serum t umour markers in patients with testicular masses should, in particular , be emphasized together with the significance of gynaecomastia in the young adult male.