title: Spatial variation and temporal trends of testicular cancer in Great Britain.
abstract: Increases in testicular cancer incidence have been reported in several countries over a long period. Geographical variability has also been reported in some studies. We have investigated temporal trends and spatial variation of testicular cancer at ages 20-49 in Britain. Temporal trends in testicular cancer incidence were examined, 1974 to 1991 and in mortality, 1981-1997. Spatial variation in incidence was analysed across electoral wards, 1975 to 1991. We used Poisson regression to examine for regional and socio-economic effects and Bayesian mapping techniques to analyse small-area spatial variability. Incidence increased from 6.5 to 11.1 per 100 000 in men at ages 20-34, and from 5.6 to 9.7 per 100 000 in men at ages 35-49, while mortality declined by 50% in both age groups. Risks of testicular cancer varied across regional cancer registries, ranging from 0.79 (95% CI: 0.73-0.84) to 1.32 (95% CI: 1.25-1.38), and was higher in the most affluent compared with the most deprived areas. Analyses within 2 regions (one predominantly urban, the other predominantly rural) did not indicate any localized geographical clustering. The increasing incidence contrasted with a decreasing mortality over time in Great Britain, similar to that found in other countries. The higher risk in more affluent areas is not consistent with findings on social class at the individual level. The absence of any marked geographical variability at small area scale argues against a geographically varying environmental factor operating strongly in the aetiology of testicular cancer.
authors.affiliation: The Small Area Health Statistics Unit, Department of Epidemiology and Public Health, Imperial College School of Medicine, Norfolk Place, London, W2 1PG, UK.
authors.forename: M B
authors.initials: MB
authors.lastname: Toledano
authors.forename: L
authors.initials: L
authors.lastname: Jarup
authors.forename: N
authors.initials: N
authors.lastname: Best
authors.forename: J
authors.initials: J
authors.lastname: Wakefield
authors.forename: P
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000328:Adult; D000367:Age Factors; D005843:Geography; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012424:Rural Population; D013736:Testicular Neoplasms / Q000453:epidemiology*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014505:Urban Population