In otherwise healthy men between the ages of 20 and 35 years, testicular cancer has become the most common type of malignancy. The occurrence of the cancer, which still represents only 1 percent of diagnosed cancers, has doubled over the past 10 to 15 years, according to Mark DeGuenther, MD, of Urology Centers of Alabama, P.C. "While the incidence of this cancer has doubled, it is still extremely low," DeGuenther said. "About two out of every 100,000 men are diagnosed with the malignancy." The American Cancer Society estimates that about 8,090 new cases of testicular cancer will be diagnosed during 2008 in the United States and that 380 men will die of the cancer this year. The reasons for the increase are not clear, but DeGuenther thinks it may be related to increased ultrasound screening for male factor infertility. "Prostate cancer has also increased, but the reason for that is because better tests have been developed for its diagnosis," he said. "That's not the case for testicular cancer. We're just finding more." Risk factors for developing testicular cancer include white race, smoking and a family history of the disease. The number-one cause for the cancer is cryptorchidism, according to Clint Holladay, MD, a radiology oncologist with Trinity Medical Center. "Having an undescended testicle raises a man's cancer risk by 35 percent," he said. "Researchers are also looking at a history of sexually transmitted diseases and HIV as possible risk factors." Scientists are also finding that infertility may be a significant risk factor. A study published in the November 2005 issue of The Journal of Urology stated that infertile men with abnormal semen analysis are 20 times more likely to develop testicular cancer. Researchers at New York Presbyterian Hospital/Weill Cornell Medical Center reviewed the medical records of more than 3,800 infertile men seen over 10 years by a New York urologist. A total of 10 men had testicular cancer — a rate about 20 times higher than the general public — and two of them had a history of undescended testicles. Those figures mean that the odds of finding testicular cancer in an infertile man are about one in 500. "That sounds small, but the odds are enough that men who have an abnormal sperm count or are infertile should be referred to a urologist for examination and possible ultrasound screening," the principal investigator stated. University of California researchers conducted a study in 2007 based on data from more than 51,000 couples who were evaluated for infertility between 1965 and 1998. This study, published in Urology Times, substantiated the link to infertility. DeGuenther points out that testicular cancer is one of the most curable forms of cancer. According to the National Cancer Institute, the five-year relative survival rate for all men with this cancer is 96 percent. If the cancer hasn't spread outside the testicle, the five-year relative survival rate is 99 percent. Even if the cancer has spread to nearby lymph nodes, the five-year relative survival rate is 96 percent. "Testicular cancer is very rare, but it is also very curable. The biggest problem we see in diagnosing the disease is that men delay reporting symptoms to their physician," DeGuenther said. "It's not because they don't think they have cancer, it's because they're afraid they do." The average length of delay in seeing a doctor is about three months, DeGuenther points out. If a man waits too long and the cancer spreads beyond the lymph nodes, his five-year survival rate drops to around 70 percent, according to the National Cancer Institute. "This is usually a rapidly growing cancer. If there's something there, we need to check it. If the man's worse fear is true, it's better if we can treat it early," DeGuenther said. Patient education is critical to early diagnosis of testicular cancer, Holladay said, and he urges primary care physicians to do early screenings on men who have a family history of the disease or any of the other significant risk factors. "Since a painless mass in the testicle is usually the first symptom of the cancer, physicians should stress the importance of self examination to their patients and show them how to do one," he said. Holladay recommended doing the examination during a hot shower because the scrotum drops in the heat, allowing for better access to the testicles. "These examinations are important because they allow a man to become familiar with how his testicles feel. For example, the epididymis is located near the scrotum and can feel like a mass," he said. "By knowing the natural feel, you're more likely to notice when there's a problem." DeGuenther points out that there is no need for panic because of the increasing incidence of testicular cancer, but awareness by physicians and their male patients can save lives.