title: Noncancer causes of death in survivors of testicular cancer.
abstract: BACKGROUND
  Although modern treatments for testicular cancer are associated with increased survival, the long-term health effects of these treatments are unclear. We conducted a population-based study to quantify the long-term risks of mortality from noncancer causes among men with testicular cancer.
  
  
  METHODS
  We identified 38,907 one-year survivors of testicular cancer within 14 population-based cancer registries in North America and Europe (from 1943 through 2002). We used data from these registries to calculate standardized mortality ratios (SMRs) for noncancer deaths and to evaluate associations between histology, age at testicular cancer diagnosis, calendar year of diagnosis, and initial treatment and the risk of noncancer mortality. All statistical tests were two-sided.
  
  
  RESULTS
  A total of 2942 deaths from all noncancer causes were reported after a median follow-up of 10 years, exceeding the expected number of deaths from all noncancer causes in the general population by 6% (SMR = 1.06, 95% confidence interval [CI] = 1.02 to 1.10); the noncancer standardized mortality ratios did not differ statistically significantly between patients diagnosed before and after 1975, when cisplatin-based chemotherapy came into widespread use. Compared with the general population, testicular cancer survivors had higher mortality from infections (SMR = 1.28, 95% CI = 1.12 to 1.47) and from digestive diseases (SMR = 1.44, 95% CI = 1.26 to 1.64). Mortality from all circulatory diseases was statistically significantly elevated in men diagnosed with testicular cancer before age 35 years (1.23, 95% CI = 1.09 to 1.39) but not in men diagnosed at older ages (SMR = 0.94; 95% CI = 0.89 to 1.00). Men treated with chemotherapy (with or without radiotherapy) in 1975 or later had higher mortality from all noncancer causes (SMR = 1.34, 95% CI = 1.15 to 1.55), all circulatory diseases (SMR = 1.58, 95% CI = 1.25 to 2.01), all infections (SMR = 2.48, 95% CI = 1.70 to 3.50), and all respiratory diseases (SMR = 2.53, 95% CI = 1.26 to 4.53). Testicular cancer patients who were younger than 35 years at diagnosis and were treated with radiotherapy alone in 1975 or later had higher mortality from all circulatory diseases (SMR = 1.70, 95% CI = 1.21 to 2.31) compared with the general population.
  
  
  CONCLUSIONS
  Men who have survived for at least 1 year after being diagnosed with testicular cancer have a slightly higher risk of dying from noncancer causes, including infections, digestive diseases, and circulatory diseases, than the general population. Men treated with chemotherapy in 1975 or later may be at particularly high risk.
authors.affiliation: Department of Clinical Cancer Research, Rikshospitalet-Radiumhospitalet Trust, Oslo, Norway. s.d.fossa@medisin.uio.no
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.forename: Ethel
authors.initials: E
authors.lastname: Gilbert
authors.forename: Graça M
authors.initials: GM
authors.lastname: Dores
authors.forename: Jinbo
authors.initials: J
authors.lastname: Chen
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.forename: Sara
authors.initials: S
authors.lastname: Schonfeld
authors.forename: Hans
authors.initials: H
authors.lastname: Storm
authors.forename: Per
authors.initials: P
authors.lastname: Hall
authors.forename: Eric
authors.initials: E
authors.lastname: Holowaty
authors.forename: Aage
authors.initials: A
authors.lastname: Andersen
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
authors.forename: Michael
authors.initials: M
authors.lastname: Andersson
authors.forename: Magnus
authors.initials: M
authors.lastname: Kaijser
authors.forename: Mary
authors.initials: M
authors.lastname: Gospodarowicz
authors.forename: Randi
authors.initials: R
authors.lastname: Cohen
authors.forename: Eero
authors.initials: E
authors.lastname: Pukkala
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012537:Scandinavian and Nordic Countries; D017741:Survivors; D013736:Testicular Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D013997:Time Factors