title: A population-based analysis of increased incidence and improved survival of testicular cancer patients in Iceland.
abstract: OBJECTIVE
  For unknown reasons the incidence of testicular cancer has risen dramatically in many industrialized countries. At the same time, the prognosis for these patients has improved even more significantly. This has mostly been explained by the introduction of an effective cisplatin-based multidrug chemotherapy regimen for patients with metastatic or recurrent disease, but better diagnostic tools and surveillance may also play a role. In this population-based study the clinical behaviour of testicular cancer cases (n = 198) in Iceland between 1955 and 1999 was investigated, with a special emphasis on changes in incidence, staging and survival.
  
  
  METHODS
  The tumours were staged and pathologically classified and the crude probability of survival evaluated. The incidence was calculated for the whole period and further clinical evaluation was done for all the patients diagnosed after 1970 (n = 172).
  
  
  RESULTS
  Of 198 patients, 111 (58%) were diagnosed with seminomas and 82 with non-seminomas (42%). Age-adjusted incidence increased from 2.2 per 100,000 men between 1955 and 1959 to 5.3 per 100,000 men between 1995 and 1999 (p < 0.01). More patients were diagnosed with localized disease (stage I) in the second compared to the first time period of the study: 71% vs 52% respectively (p < 0.01). After the introduction of cisplatin-based multidrug chemotherapy in Iceland in 1978, 5-year survival has increased from 67% in the period 1955-77 to 96% in the period 1978-99.
  
  
  CONCLUSIONS
  During the study period the incidence of testicular cancer in Iceland increased almost threefold. After multidrug chemotherapy was introduced in 1978 only two patients have died from the disease. Since 1987, patients with stage I disease have been followed with surveillance after orchiectomy, without any deaths. Our population-based findings of increased incidence, lower staging and improved survival of patients with testicular cancer in Iceland are important for planning future treatment strategies. The availability of effective treatment, even for patients with advanced disease, stresses the importance of reducing treatment-related morbidity (infertility and secondary malignancies).
authors.affiliation: Department of Urology, Landspitalinn University Hospital, Reykjavik, Iceland. tomasgudbjartsson@hotmail.com
authors.forename: Tomas
authors.initials: T
authors.lastname: Gudbjartsson
authors.forename: Kjartan
authors.initials: K
authors.lastname: Magnusson
authors.forename: Jon
authors.initials: J
authors.lastname: Bergthorsson
authors.forename: Rosa B
authors.initials: RB
authors.lastname: Barkardottir
authors.forename: Bjarni A
authors.initials: BA
authors.lastname: Agnarsson
authors.forename: Asgeir
authors.initials: A
authors.lastname: Thoroddsen
authors.forename: Gudmundur Vikar
authors.initials: GV
authors.lastname: Einarsson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D012189:Retrospective Studies; D018239:Seminoma / Q000401:mortality* / Q000473:pathology*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality* / Q000473:pathology*; D013997:Time Factors