title: Disparities in Adolescent and Young Adult Survival After Testicular Cancer Vary by Histologic Subtype: A Population-Based Study in California 1988-2010.
abstract: OBJECTIVE
  Testicular cancer is the most common cancer among adolescent and young adult (AYA) men 15-39 years of age. This study aims to determine whether race/ethnicity and/or neighborhood socioeconomic status (SES) contribute independently to survival of AYAs with testicular cancer.
  
  
  METHODS
  Data on 14,249 eligible AYAs with testicular cancer diagnosed in California between 1988 and 2010 were obtained from the population-based California Cancer Registry. Multivariable Cox proportional hazards regression was used to examine overall and testicular cancer-specific survival and survival for the seminoma and nonseminoma histologic subtypes according to race/ethnicity, census-tract level neighborhood SES, and other patient and clinical characteristics.
  
  
  RESULTS
  Compared with White AYAs, Hispanic AYAs had worse overall and testicular cancer-specific survival (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.07-1.37) and Black AYAs had worse overall survival (HR, 1.41; 95% CI, 1.01-1.97), independent of neighborhood SES and other demographic and clinical factors. Racial/ethnic disparities in survival were more pronounced for nonseminoma than for seminoma. AYAs residing in middle and low SES neighborhoods experienced worse survival across both histologic subtypes independent of race/ethnicity and other factors, while improvements in survival over time were more pronounced for seminoma. Longer time to treatment was also associated with worse survival, particularly for AYAs with nonseminoma.
  
  
  CONCLUSIONS
  Among AYAs, race/ethnicity, and neighborhood SES are independently associated with survival after testicular cancer. Variation in disparities by histologic type according to demographic factors, year of diagnosis, and time to treatment may reflect differences in prognosis and extent of treatment for the two histologies.
authors.affiliation: 1 Cancer Prevention Institute of California , Fremont, California.
authors.forename: Mindy C
authors.initials: MC
authors.lastname: DeRouen
authors.affiliation: 2 School of Public Health, University of California , Berkeley, California.
authors.forename: Mahasin
authors.initials: M
authors.lastname: Mujahid
authors.affiliation: 3 Department of Medicine/Oncology, Stanford University Medical Center , Stanford, California.
authors.forename: Sandy
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: 1 Cancer Prevention Institute of California , Fremont, California.|4 Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine , Stanford, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012042:Registries; D018239:Seminoma / Q000208:ethnology / Q000401:mortality; D012923:Social Class; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: disparities; epidemiology; neighborhood SES; race/ethnicity; survival; testicular cancer
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