October 1, 1997
NEW YORK (Reuters) - The drug which 'cures' the vast majority of testicular cancers may also increase a survivor's risk for a second cancer in later life.
"Men with testicular cancer may be at increased risk of secondary leukemia, sarcoma, and cancers of the lung, gastrointestinal tract, and other urogenital sites," concludes an international team of researchers led by Dr. Lois Travis of the National Cancer Institute (NCI) in Bethesda, Maryland.
Their report appears in the current issue of the Journal of the National Cancer Institute (JNCI).
Chemotherapy treatments involving the heavy metal compound cisplatin began in the early 1970s. Since then, men diagnosed with testicular cancer (once the leading cause of cancer deaths among young men) have achieved a cure rate of nearly 95%.
But what about the survivor's risk for cancer recurrence in later life? The NCI-led team worked with data from cancer registries based in Canada, Denmark, Finland, Sweden, the Netherlands, and the United States. They assembled a list of 29,000 men, each of whom had survived testicular cancer for at least one year after initial diagnosis. Some of the men had been diagnosed (and cured) as far back as the 1930s and 1940s. Most had survived their cancers for an average of 10 years.
The researchers found that the "risks for second cancers were significantly elevated in all (national) registries," compared with men who had no history of prior testicular tumors.
The study found that a survivor's risk for a subsequent cancer seems to increase with passing years. For example, 25 years after diagnosis of testicular cancer, survivors faced a 15.7% risk of second cancer - compared with a 9.3% risk for men who had never been stricken with the disease. By 30 years after diagnosis, "one in five men (22.6%) with testicular tumors would be expected to develop a second cancer," the researchers say, "...compared with about one in eight men (13.1%) in the general population."
Leukemias, as well as urogenital, stomach, intestinal, and lung cancers were all found at higher incidence in testicular cancer survivors, compared to men without such prior histories.
No one is sure exactly why these men face heightened risks for second cancers. But the study authors point out that "concern has been raised about the possible carcinogenic (consequences) of cisplatin, which is retained in numerous tissues long after completion of treatment." They believe their findings should "prompt clinicians to follow patients with testicular cancer for life, even those cured decades ago."
In a commentary on the study (also published in JNCI), Drs. Craig Nichols and Patrick Loehrer of the Indiana University School of Medicine stress that treatment of testicular tumors "has evolved during the past few decades."
Chemotherapy is now of shorter duration: treatments that lasted years in the 1970s are often concluded in weeks today. Nichols and Loehrer believe this means that patients treated with cisplatin in the 1990s could face lower risks of secondary cancers, compared with those patients exposed to the drug in decades past.
SOURCE: Journal of the National Cancer Institute (1997;89(19):1394-1395, 1429-1439)
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