Showing papers by "Cancer Epidemiology Unit published in 1999"
TL;DR: Mortality from ischemic heart disease among vegetarians was 24% lower in vegetarians than in nonvegetarians, and was greater at younger ages and was restricted to those who had followed their current diet for >5 y.
454 citations
TL;DR: The association between soya foods and breast cancer risk was investigated in a prospective study of 34 759 women in Hiroshima and Nagasaki, Japan and results were similar in women diagnosed before age 50 and at ages 50 and above.
Abstract: The association between soya foods and breast cancer risk was investigated in a prospective study of 34759 women in Hiroshima and Nagasaki, Japan. Women completed dietary questionnaires in 1969-1970 and/or in 1979-1981 and were followed for incident breast cancer until 1993. The analysis involved 427 cases of primary breast cancer in 488989 person-years of observation. The risk for breast cancer was not significantly associated with consumption of soya foods: for tofu, relative risks adjusted for attained age, calendar period, city, age at time of bombings and radiation dose to the breast were 0.99 (95% CI 0.80-1.24) for consumption two to four times per week and 1.07 (0.78-1.47) for consumption five or more times per week, relative to consumption once a week or less; for miso soup, relative risks were 1.03 (0.81-1.31) for consumption two to four times per week and 0.87 (0.68-1.12) for consumption five or more times per week, relative to consumption once a week or less. These results were not materially altered by further adjustments for reproductive variables and were similar in women diagnosed before age 50 and at ages 50 and above. Among 17 other foods and drinks examined only dried fish (decrease in relative risk with increasing consumption) and pickled vegetables (higher relative risk with higher consumption) were significantly related to breast cancer risk; these associations were not prior hypotheses and, because of the large number of comparisons made, they may be due to chance.
265 citations
TL;DR: The health of vegetarians in this study is generally good and compares favorably with that of the nonvegetarian control subjects, and that vegans in Britain may be at risk for iodine deficiency.
243 citations
TL;DR: Oral contraceptives seem to have their main effect on mortality while they are being used and in the 10years after use ceases, which in past users is similar to that in never users.
Abstract: Objective: To describe the long term effects of the use of oral contraceptives on mortality. Design: Cohort study with 25year follow up. Details of oral contraceptive use and of morbidity and mortality were reported six monthly by general practitioners. 75% of the original cohort was “flagged” on the NHS central registers. Setting: 1400 general practices throughout Britain. Subjects: 46000 women, half of whom were using oral contraceptives at recruitment in 1968-9.Median age at end of follow up was 49 years. Main outcome measures: Relative risks of death adjusted for age, parity, social class, and smoking. Results: Over the 25year follow up 1599deaths were reported. Over the entire period of follow up the risk of death from all causes was similar in ever users and never users of oral contraceptives (relative risk=1.0, 95% confidence interval 0.9 to 1.1; P=0.7) and the risk of death for most specific causes did not differ significantly in the two groups. However, among current and recent (within 10years) users the relative risk of death from ovarian cancer was 0.2(0.1to 0.8; P=0.01), from cervical cancer 2.5(1.1to 6.1; P=0.04), and from cerebrovascular disease 1.9(1.2to 3.1,P=0.009). By contrast, for women who had stopped use >=10 years previously there were no significant excesses or deficits either overall or for any specific cause of death. Conclusion: Oral contraceptives seem to have their main effect on mortality while they are being used and in the 10years after use ceases. Ten or more years after use ceases mortality in past users is similar to that in never users.
222 citations
TL;DR: A quantitative review of the data from eight prospective epidemiological studies suggests that there are no large differences in circulating hormones between men who subsequently go on to develop prostate cancer and those who remain free of the disease.
Abstract: This paper presents a quantitative review of the data from eight prospective epidemiological studies, comparing mean serum concentrations of sex hormones in men who subsequently developed prostate cancer with those in men who remained cancer free. The hormones reviewed have been postulated to be involved in the aetiology of prostate cancer: androgens and their metabolites testosterone (T), non-SHBG-bound testosterone (non-SHBG-bound T), di-hydrotestosterone (DHT), androstanediol glucuronide (A-diol-g), androstenedione (A-dione), dehydroepiandrosterone sulphate (DHEAS), sex hormone binding globulin (SHBG), the oestrogens, oestrone and oestradiol, luteinizing hormone (LH) and prolactin. The ratio of the mean hormone concentration in prostate cancer cases to that of controls (and its 95% confidence interval (CI)) was calculated for each study, and the results summarized by calculating the weighted average of the log ratios. No differences in the average concentrations of the hormones were found between prostate cancer cases and controls, with the possible exception of A-diol-g which exhibited a 5% higher mean serum concentration among cases relative to controls (ratio 1.05, 95% CI 1.00-1.11), based on 644 cases and 1048 controls. These data suggest that there are no large differences in circulating hormones between men who subsequently go on to develop prostate cancer and those who remain free of the disease. Further research is needed to substantiate the small difference found in A-diol-g concentrations between prostate cancer cases and controls.
208 citations
Journal Article•
TL;DR: The breast and endometrial cancers that are diagnosed in HRT users are less aggressive clinically than cancers in never-users but, as yet, there is little reliable information about the relationship between use of HRT and mortality from these cancers.
Abstract: At least 20 million women in developed countries are estimated to be currently using hormone replacement therapy (HRT). Almost 100 epidemiological studies have reported on the relationship between the use of HRT and the risk of cancer of female reproductive organs, namely the breast, uterus or ovary. Cancer at these sites is common and there are a priori reasons why the use of hormonal therapy to 'replace' the endogenous production of ovarian hormones after the menopause might increase the risk of these cancers. The available evidence indicates that the risk of breast cancer or endometrial cancer is increased while women are using HRT, the risk increasing with increasing duration of use. Most of the evidence about these cancers relates to use of HRT preparations containing oestrogens alone. The limited evidence about combination therapy, with oestrogens and progestogens, suggests that, compared to oestrogens alone, the effect on the breast is similar, but the effect on the endometrium is diminished, the diminution in risk being greater the more days each month that progestogens are used. The effect of HRT on breast cancer wears off after use ceases and has disappeared largely, if not wholly, within 5 years, whereas the effects on endometrial cancer take longer to wear off, if at all. The breast and endometrial cancers that are diagnosed in HRT users are less aggressive clinically than cancers in never-users but, as yet, there is little reliable information about the relationship between use of HRT and mortality from these cancers. For other cancer sites, the existing data about the effects of HRT are inconclusive. The longer the period of use of HRT, the greater the excess incidence of cancer of the breast and endometrium is likely to be. Use of HRT for short periods of time should have little effect on the incidence of these cancers. The cumulative excess incidence in 1000 women who used HRT for 10 years, beginning at age 50, is estimated to be six for breast cancer, 42 for endometrial cancer in women with an intact uterus using oestrogen therapy alone and about 20 for endometrial cancer in women with an intact uterus using oestrogen-progestogen combinations. The estimate for combined therapy is based on small numbers and may well vary with the type of preparation used. The overall balance between the excess incidence of these cancers and other effects of HRT needs to be evaluated carefully and will require more reliable data than exist at present.
172 citations
01 May 1999
TL;DR: The evidence available suggests that widespread adoption of a vegetarian diet could prevent approximately 40,000 deaths from IHD in Britain each year.
Abstract: Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis. No differences in mortality from common cancers have been established. There is no evidence of adverse effects on mortality. Much more information is needed, particularly on other causes of death, other morbidity including osteoporosis, and long-term health in vegans. The evidence available suggests that widespread adoption of a vegetarian diet could prevent approximately 40,000 deaths from IHD in Britain each year.
156 citations
TL;DR: The findings confirm previous suggestions showing an increased risk of ICC among HIV‐infected women and have important implications at the individual and public health levels.
Abstract: Although invasive cervical cancer (ICC) has been included among the AIDS-defining conditions since 1993, it remains controversial whether HIV infection increases the risk of developing such neoplasm. In this study, ICC risk was longitudinally investigated among 1,340 HIV-positive intravenous drug user (IDU), 811 HIV-negative IDU, and 801 HIV-positive heterosexual women. These women, aged 15-49 years, were followed up at the Italian HIV Seroconverter Study, at the San Patrignano Community (Rimini, North Italy), and in South-eastern France (the DMI-2 study). The number of observed cases of ICC was compared with the expected one, based on ICC incidence rates among women of the same age in the general population of Italy or France, and standardized incidence ratios (SIR) were computed; 9,070 person-years of observation were accumulated among HIV-positive women and 2,310 among HIV-negative ones. Ten cases of ICC were diagnosed among HIV-positive women (SIR = 12.8): ICC risk was apparently higher among HIV-positive IDU (SIR = 16.7) than among heterosexual women (SIR = 6.7). No cases of ICC were diagnosed among HIV-negative IDU women admitted to the San Patrignano Community (0.15 cases were expected). Our findings confirm previous suggestions showing an increased risk of ICC among HIV-infected women and have important implications at the individual and public health levels.
120 citations
TL;DR: Melanomas of the soles and palms resemble other cutaneous melanomas in their association with sun exposure, but are distinguished from them by their strong positive associations with nevi on thesoles, previous penetrative injury, and exposure to agricultural chemicals, and by their inverse association with smoking.
Abstract: Objectives: Because the factors that influence risk of acral melanomas on the soles and palms in White populations are unknown, we investigated these in a multi-center case-control study.
115 citations
TL;DR: The results appear to exclude a contribution greater than one‐third for genetic predisposition in the development of cancer in the general population, thus pointing to the earlier confirmed substantial role of environment.
Abstract: Twin studies integrate genetic and environmental (including physical environment and life-style) information by comparing monozygotic and dizygotic twins for the occurrence of disease. Our objectives were to compare cancer incidence in twins with national rates and to estimate both the probability that co-twins of affected twins may develop cancer and the importance of genetic predisposition and environment in cancer development. The nationwide record linkage of the Finnish Twin Cohort Study, the Finnish Cancer Registry and the Central Population Register allowed the follow-up of 12,941 same-sexed twin pairs for incident primary cancers from 1976 to 1995. Zygosity was determined by use of a validated questionnaire in 1975. Methods included calculation of standardized incidence ratios and concordances and fitting of structural equation models. A total of 1,613 malignant neoplasms occurred in the cohort. The overall cancer incidence among twins resembled that among the general population. Monozygotic co-twins of affected twins were at 50% higher risk than were dizygotic co-twins. Based on genetic modeling, inherited genetic factors accounted for 18% (95% confidence interval 4-32%) of the liability in inter-individual variation in the risk of overall cancer, while non-genetic factors shared by twins accounted for 7% (0-16%) and unique environmental factors for 75% (65-85%). Our results appear to exclude a contribution greater than one-third for genetic predisposition in the development of cancer in the general population, thus pointing to the earlier confirmed substantial role of environment.
105 citations
TL;DR: The hypothesis is that relatively high oestradiol concentrations in premenopausal women are also associated with an increase in breast cancer risk, and more data are needed to confirm this and to investigate the possible roles of other sex hormones.
Abstract: Breast cancer risk is increased by early menarche and late menopause, suggesting that the long duration of exposure of the breasts to the high levels of ovarian steroids in premenopausal women increases risk. Recent prospective studies have shown that postmenopausal women who develop breast cancer have significantly greater prediagnostic serum concentrations of oestradiol than postmenopausal women who remain healthy. Estimation of long-term oestradiol concentrations in premenopausal women is difficult, and few data are available from prospective studies, but these are compatible with the hypothesis that relatively high oestradiol concentrations in premenopausal women are also associated with an increase in breast cancer risk. Women in populations with low breast cancer rates have low serum oestradiol concentrations both before and after the menopause. The serum concentration of oestradiol is probably a major determinant of breast cancer risk, but more data
TL;DR: These results confirm previous associations and may provide additional clues to some determinants of hematolymphopoietic malignancies in women.
Abstract: Background:
The etiology of lymphomas, leukemias, and multiple myeloma is still largely unknown. The known risk factors (ionizing radiation, solvent exposure, pesticide exposure, immunosuppression) explain only a small proportion of the cases that occur.
Methods:
We conducted a multicenter population-based case-control study on hematolymphopoietic malignancies in Italy and interviewed 2,011 women (1,183 cases and 828 controls).
Results:
There was a suggestion of a positive association between smoking and the risk of non-Hodgkin's lymphoma + chronic lymphocytic leukemia. A slight increased risk of leukemias was observed among women using permanent hair dye. Housewives were at increased risk for leukemia and multiple myeloma. The risk of non-Hodgkin's lymphomas + chronic lymphocytic leukemia, leukemias, multiple myeloma, and Hodgkin's disease increased among women employed as hairdressers and textile workers. Teachers were at increased risk for non-Hodgkin's lymphomas + chronic lymphocytic leukemia, leukemias, and Hodgkin's disease.
Conclusions:
These results confirm previous associations and may provide additional clues to some determinants of hematolymphopoietic malignancies in women. Am. J. Ind. Med. 36:60–69, 1999. © 1999 Wiley-Liss, Inc.
TL;DR: A weak positive association with duration and some evidence that the excess relative risk for ovarian cancer declined with time since last use are found, compatible with a promoting effect of HRT in ovarian carcinogenesis.
Abstract: The relationship between hormonal therapy for menopause (hormone replacement therapy, HRT) and the risk of epithelial ovarian cancer was evaluated in a collaborative re-analysis of 4 European case-control studies, 2 conducted in Greece and 1 each in Italy and the United Kingdom, including a total of 1,470 ovarian cancer cases and 3,271 hospital controls. Odds ratios (ORs) for HRT use were derived after allowance for study centre, age, socio-economic level, parity, menopausal status, type of menopause, age at menopause and oral contraceptive use. Overall, 109 (8.0%) ovarian cancer cases and 146 (4.7%) controls had ever used HRT, corresponding to an adjusted OR of 1.71 (95% confidence interval 1.30-2.25). The point estimates of the OR were 1.77 in the first Greek study, 1.40 in the second Greek study, 1.66 in the Italian study and 1.68 in the British study. Adjustment for possible confounders, including menopausal status, type of menopause, age at menopause and oral contraceptive use, slightly increased the OR. Limiting the analysis to women with information on relevant aspects of HRT use revealed a weak positive association with duration and some evidence that the excess relative risk for ovarian cancer declined with time since last use. These findings are compatible with a promoting effect of HRT in ovarian carcinogenesis. It is also possible, however, that the positive association reflects chance or selective administration of HRT to high-risk individuals, since until recently in Europe HRT was prescribed mainly for alleviation of peri-menopausal symptoms.
TL;DR: It is suggested that the increasing intake of animal fat and/or protein may have played a key role in reducing cerebrovascular disease in Japan.
TL;DR: Risks associated with testicular or groin injuries were higher in the non-seminoma group, as was the risk for a history of sexually transmitted disease, and the protective effect of a late puberty was more marked for tumours of other histologies.
Abstract: There are two main histological groups of testicular germ cell tumours, which may have different risk factors Some authors have analysed potential risk factors by histological group but few consistent differences have been identified In this paper we examine risk factors for pure seminoma and other tumours using data from the United Kingdom case control study of testicular cancer Seven hundred and ninety-four cases were included in the study, each with a matched control; 400 cases had pure seminoma tumours, and 394 had other testicular tumours The risk of seminoma associated with undescended testis was slightly higher than that for other tumours (odds ratio of 53 compared with 30) When split at the median age at diagnosis, this difference was greater in men aged 32 and over (odds ratio of 119 compared with 51) than in the younger men (30 compared with 25) Risks associated with testicular or groin injuries were higher in the non-seminoma group, as was the risk for a history of sexually transmitted disease The protective effect of a late puberty was more marked for tumours of other histologies Some differences were also detected for participation in sports Whilst some of the differences detected may have arisen by chance, the stronger association between undescended testis and pure seminoma has been identified by a number of other studies and may reflect a genuine difference in aetiology
TL;DR: The evidence, for the first time, of more favorable trends among post-World War II generations is thought to reflect reduced exposure to UV rays, particularly if UV radiation also acts as a tumor promoter.
Abstract: Trends in melanoma incidence by anatomic site were examined in Canada where ascertainment of cancer has been of a high standard The analysis included 41,239 malignant melanomas registered between 1969 and 1993 and used an age, period and cohort modeling approach The estimated annual increase was 48% for males and 31% for females but slowed appreciably in the later years The lifetime risk of melanoma appeared to have peaked with women born about 1934 and men born about 1944 The age-standardized rates have now stabilized for women and are expected to plateau for men in the near future The largest relative increases occurred for the upper limbs followed by the trunk for both sexes Comparable generation effects were observed for intermittently exposed sites but the patterns of trend differed between sites for men and women This supports effects due to sex- and site-specific pattern of sun exposure The evidence, for the first time, of more favorable trends among post-World War II generations is thought to reflect reduced exposure to UV rays This may possibly be the earliest signs of the impact of primary prevention programs, particularly if UV radiation also acts as a tumor promoter
TL;DR: Over the past few years, age-standardised mortality rates have levelled off or declined for most cancer sites in the European Union, with the main exception of lung cancer in women.
TL;DR: This study implies that the relatively low BMI of vegetarians and vegans does cause small changes in SHBG and in post-menopausal oestradiol, but that the composition of vegetarian diets may not have any additional effects on these hormones.
Abstract: Endogenous oestradiol is strongly associated with breast cancer risk but its determinants are poorly understood. To test the hypothesis that vegetarians have lower plasma oestradiol and higher sex hormone-binding globulin (SHBG) than meat-eaters we assayed samples from 640 premenopausal women (153 meat-eaters, 382 vegetarians, 105 vegans) and 457 post-menopausal women (223 meat-eaters, 196 vegetarians, 38 vegans). Vegetarians and vegans had lower mean body mass indices (BMI) and lower plasma cholesterol concentrations than meat-eaters, but there were no statistically significant differences between meat-eaters, vegetarians and vegans in pre- or post-menopausal plasma concentrations of oestradiol or SHBG. Before adjusting for BMI there were small differences in the direction expected, with the vegetarians and vegans having higher SHBG and lower oestradiol (more noticeable amongst post-menopausal women) than the meat-eaters. These small differences were essentially eliminated by adjusting for BMI. Thus this study implies that the relatively low BMI of vegetarians and vegans does cause small changes in SHBG and in post-menopausal oestradiol, but that the composition of vegetarian diets may not have any additional effects on these hormones.
TL;DR: Responses to simple questions about nutrition were associated with mortality, and associations were broadly similar for deaths from ischaemic heart disease, cancer and all other causes combined, and were not greatly attenuated by adjusting for potential confounding factors including social class.
Abstract: Objective:To determine whether responses to simple dietary questions are associated with specific causes of death.Design:Self-reported frequency intakes of various classes of foods and data on confounding factors were collected at the baseline survey. Death notifications up to 31 December 1997 were ascertained from the Office for National Statistics. Relative risk (RR) of death and 95% confidence intervals (CI) associated with baseline dietary factors were calculated by Cox regression.Setting:Prospective follow-up study based on five UK general practices.Subjects:Data were used from 11 090 men and women aged 35–64 years (81% of the eligible patient population) who responded to a postal questionnaire in 1989.Results:After 9 years of follow-up, 598 deaths were recorded, 514 of these among the 10 522 subjects with no previous history of angina. All-cause mortality was positively associated with age, smoking and low social class, as expected. Among the dietary variables, all-cause mortality was significantly reduced in participants who reported relatively high consumption of vegetables, puddings, cakes, biscuits and sweets, fresh or frozen red meat (but not processed meat), among those who reported using polyunsaturated spreads and among moderate alcohol drinkers. These associations were broadly similar for deaths from ischaemic heart disease (IHD), cancer and all other causes combined, and were not greatly attenuated by adjusting for potential confounding factors including social class.Conclusions:Responses to simple questions about nutrition were associated with mortality. These findings must be interpreted with caution since residual confounding by dietary and lifestyle factors may underlie the associations.
TL;DR: Endogenous hormones and the aetiology of breast cancer [commentary] is described.
Abstract: Received: 16 July 1999 Accepted: 22 July 1999 Published: 23 August 1999 © Current Science Ltd Important note about how to cite this article This article is also available online in the Breast Cancer Research website. To avoid confusion, please ensure that only the online version of the article is cited in any reference, as follows: Key TJ, Verkasalo PK: Endogenous hormones and the aetiology of breast cancer [commentary]. http://breast-cancer-research.com/ vol1no1/23aug99/editorial/2
TL;DR: The EUROCLUS study assembled incidence data for 13,551 cases of childhood leukaemia diagnosed between 1980 and 1989 in 17 countries to suggest that exposure to localised epidemics of one or more common infectious agent may contribute to the development ofLeukaemia.
University of Illinois at Urbana–Champaign1, University of Washington2, Fred Hutchinson Cancer Research Center3, University of Guadalajara4, Novartis5, University of Southern Maine6, Cancer Epidemiology Unit7, University of California, Berkeley8, Medical University of South Carolina9, University of New Mexico10, University of Hawaii at Manoa11, Cancer Prevention Institute of California12
TL;DR: The observed associations are not consistent with findings from studies of breast cancer in women and probably do not represent causal relationships, suggesting that dietary factors are unlikely to be strong determinants of Breast cancer in men.
Abstract: Objectives: The purpose of this paper was to investigate the relationship between food and beverage consumption and the development of breast cancer in men. Methods: Possible relationships of dietary factors to risk of breast cancer in men were assessed in a case-control study conducted between 1983 and 1986. Cases (N=220) were ascertained from ten population-based cancer registries. Controls (N=291) were selected by random-digit dialing (
TL;DR: The SIRs of patients born in three southern Italian regions and of foreign-born persons were significantly higher than those of persons born in Piemonte and or other regions in Italy, and increased with age, possibly indicating a different susceptibility to ALS in these populations.
Abstract: Recent surveys indicate a decreasing north-to-south gradient in the mortality and incidence rates of amyotrophic lateral sclerosis (ALS) in Italy, possibly indicating a different susceptibility to ALS in these populations. Piemonte, a region of northwestern Italy, experienced a considerable migration from other regions in Italy between 1940 and 1975; we therefore analyzed the effects of place of birth and migration upon the risk of developing ALS. Data on all ALS cases occurring in Piemonte during the period 1971–1990 were collected. Standardized incidence ratios (SIRs) for patients born outside Piemonte were calculated, using the Piemonte-born population as reference. A total of 962 ALS cases were identified during the study period, corresponding to a mean annual crude incidence rate of 1.37/100,000 population (95% confidence interval, 1.29–1.46). The SIRs of patients born in three southern Italian regions and of foreign-born persons were significantly higher than those of persons born in Piemonte and or other regions in Italy, and increased with age. This observation may be explained by an interaction between environmental and genetic factors or by selective migration.
TL;DR: An introduction to the concept of relative survival is provided and some of the suggested methods of estimation are reviewed, including a particularly simple, but robust approach, based on expected and observed mortality.
Abstract: Because routinely collected survival data for cancer patients in England and Wales do not typically specify cause of death, conventional estimates of survival in cancer patients based on such data are a measure of their mortality from all causes rather than their mortality due to cancer. As a result, trends in survival over time are difficult to interpret because changes in overall survival may well reflect changes in the risk of death from other causes, rather than from the cancer of interest. One way of overcoming this problem is to use some form of ‘relative survival’ defined as a measure of survival corrected for the effect of other independent causes of death. Since this concept was first introduced, various methods for calculating relative survival have been proposed and this had led to some confusion as to the most appropriate choice of estimate. This paper aims to provide an introduction to the concept of relative survival and reviews some of the suggested methods of estimation. In addition, a particularly simple, but robust approach, is highlighted based on expected and observed mortality. This method is illustrated using preliminary data from the Office for National Statistics on cancer survival in patients born after 1939 and diagnosed with cancer during 1972–84. The examples presented, although limited to analyses on a small number of selected sites, highlight some encouraging trends in survival in people aged under 35 diagnosed with leukaemia, Hodgkin's disease and testicular cancer during this period. © 1999 Cancer Research Campaign
TL;DR: The many anti-oxidants present in the body, which differ by location, function and activity, may be part of a biologically organized system responsible for maintaining the redox potential of tissues in a manner analogous to pH regulation as discussed by the authors.
Abstract: Current dietary recommendations for vitamin intake ignore possible biological interactions whereby supplementation with individual anti-oxidants may be ineffective or even, paradoxically, harmful (Omennet al., 1996). The many anti-oxidants present in the body, which differ by location, function and activity, may be part of a biologically organized system responsible for maintaining the redox potential of tissues in a manner analogous to pH regulation (Berry and Kohen, 1999). Thus, membrane polyunsaturated fatty acids (PUFAs) are protected from
TL;DR: The present series is based on relatively small absolute numbers, and on a strict and conservative definition in terms of histological types and time of diagnosis of second primary testicular cancer, which combined the datasets from the Swiss Registries of the cantons of Vaud and Neuchatel.