Testicular Cancer Risk Factors You Shouldn't Overlook

Not smoking reduces your risk of lung cancer.

Limiting your intake of processed meats lessens your chance of stomach cancer.

The list of avoidable contributors to various cancers goes on.

But when you consider testicular cancer risk factors, men don't have much recourse in terms of lifestyle modifications.

"There are no real lifestyles, habits or activities that cause it," said Mike Craycraft, a testicular cancer survivor and clinical pharmacist who founded the nonprofit organization Testicular Cancer Society. "This is a cancer that likes to attack young, healthy men with no risk factors, unfortunately."

Although there are no known modifiable risk factors, that's not to say testicular cancer is without its predisposed threats. Age and family history are two of the major ones.

Half of men diagnosed with testicular cancer are between the ages of 20 and 34. The average age at diagnosis is 33, according to the American Cancer Society (ACS).

"The wheelhouse for testis cancer seems to be early 20s through late 40s, but I never want to ignore a testis lump if a 70-year-old guy comes into my clinic," said Jesse Mills, M.D., a urologist and the director of the Men's Clinic at UCLA in Los Angeles. "I still diagnose testis cancer in men in their 60s and early 70s, so that's why it's so important to have men be very familiar with their anatomy, and if they feel anything different, they should come see a urologist."

Mills added that testicular cancer is not the result of environmental factors as much as it is a genetic, "one-off disease."

Family history and race

Testicular cancer is one of the most inheritable diseases, according to Craycraft.

"If the father has had testicular cancer, the son is going to be four to six times more likely to develop it," he explained. "If your brothers have it, you're going to be like eight to 16 times more likely."

If a man has a first-degree relative—a parent or a sibling—with testicular cancer, he is not only more likely to develop the disease but also more likely to have it at a younger age, according to Lael Stieglitz, M.D., a urologist at Baptist MD Anderson Cancer Center in Jacksonville, Florida.

"If you get it in one testicle, you're more likely to get it in the other testicle over time," she said. "It's still rare, but you're at an increased risk."

About 1 in every 250 men develop testicular cancer at some point during their lifetime, according to the ACS. While it's an uncommon form of cancer, it's notable that the diagnosis of testicular cancer has doubled over the past 40 years.

Testicular cancer typically affects white men more than other races. However, in recent years, there's been a dramatic increase among Hispanic populations, which historically have suffered from a lack of awareness, Craycraft said.

"It's predicted by 2026, the rate in Hispanics will outpace that of Caucasians," he said.

Testicular cancer is least common in African American men, who develop it at only one-fourth the frequency seen in white men, according to the journal Urology.

Undescended testicle and GCNIS

Boys who are born with an undescended testicle (cryptorchidism) have four to six times the risk of developing testicular cancer in that testicle. An undescended testicle fails to drop into its proper position in the scrotum prior to birth. About 3 percent of babies are born with this condition, according to Cleveland Clinic.

If an orchiopexy, the surgery used to repair an undescended testicle, is performed before the boy hits puberty, the risk of testicular cancer decreases by two to three times, Stieglitz said. She added that an orchiopexy is typically an easy outpatient surgery performed in about one hour.

"Usually, the pediatricians are the ones who do the exam and find that," Stieglitz explained. "Some boys just don't have a testicle from birth and they usually get operated on earlier. Some boys, the testicle is down but will then later ascend and disappear from the scrotal sac. Those boys usually have the surgery in their preteen and teen years."

The majority of testicular cancer cases arise from the precursor lesion called germ cell neoplasia in situ (GCNIS). Approximately 50 percent of men with GCNIS develop testicular cancer within five years.

Some evidence suggests men with human immunodeficiency virus (HIV) are at a slightly higher risk of developing seminoma, one of the two main types of testicular germ cell tumors (along with nonseminoma). Klinefelter syndrome, a rare genetic condition, may also be among the testicular cancer risk factors that increase a man's vulnerability to the disease.

Samuel Haywood, M.D., a urologic oncologist at Cleveland Clinic, said it's difficult to identify men who are more susceptible to testicular cancer because of the lack of risk factors.

"The trouble is unless guys are performing testicular exams, we may miss an early window for these patients to be treated," Haywood said. "Unfortunately, the rule rather than the exception is a delay in a diagnosis, because a lot of these guys are in early adulthood, which is a time where you're not generally too engaged in the medical community."