title: Testicular cancer: a narrative review of the role of socioeconomic position from risk to survivorship.
abstract: BACKGROUND
  Testicular cancer (TC) is one of the most curable cancers. Given survival rates of close to 100% with appropriate therapy, ensuring proper treatment is essential. We reviewed and summarized the literature on the association of socioeconomic position (SEP) along the cancer control spectrum from risk factors to survivorship.
  
  
  METHODS
  We searched PubMed from 1966 to 2011 using the following terms: testicular cancer, testicular neoplasm, poverty, and socioeconomic factors, retrieving 119 papers. After excluding papers for the non-English (10) language and non-relevance (46), we reviewed 63 papers. We abstracted information on socioeconomic position (SEP), including occupation, education, income, and combinations of the 3. Five areas were examined: risk factors, diagnosis, treatment, survival, and survivorship.
  
  
  RESULTS
  Most studies examined area-based measures, not individual measures of SEP. The majority of studies found an increased risk of developing TC with high SEP though recent papers have indicated increased risk in low-income populations. Regarding diagnosis, recent papers have indicated that lower levels of education and SEP are risk factors for later-stage TC diagnosis and hence higher TC mortality. For treatment, 1 study that examined the use of radiation therapy (RT) in stage I seminoma reported that living in a county with lower educational attainment led to lower use of RT. For survival (mortality), several studies found that men living in lower SEP geographic areas experience lower survival and higher mortality.
  
  
  CONCLUSIONS
  The strongest evidence for SEP impact on testicular germ cell tumor (TGCT) was found for the risk of developing cancer as well as survival. The association of SEP with TGCT risk appears to have changed over the last decade. Given the highly curable nature of TGCT, more research is needed to understand how SEP impacts diagnosis and treatment for TGCT and to design interventions to address disparities in TGCT outcomes and SEP.
authors: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. lrichardson@cdc.gov
authors: Lisa C
authors: LC
authors: Richardson
authors: Antonio J
authors: AJ
authors: Neri
authors: Eric
authors: E
authors: Tai
authors: Jeffrey D
authors: JD
authors: Glenn
mesh_terms: D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000191:economics* / Q000401:mortality*; D011203:Poverty / Q000208:ethnology; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000191:economics* / Q000401:mortality*