BMJ 2000;321:789-792 ( 30 September )

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Risk of testicular cancer in men with abnormal semen characteristics: cohort study

Editorial by de Kretser

Rune Jacobsen, researcher, ^a Erik Bostofte, consultant, ^b Gerda Engholm, senior researcher, ^a Johnni Hansen, researcher, ^c Jørgen H Olsen, head of department, ^c Niels E Skakkebæk, professor, ^d Henrik Møller, professor. ^e

^a Centre for Research in Health and Social Statistics, Danish National Research Foundation, DK-2100 Copenhagen, Denmark, ^b Sperm Analysis Laboratory, Health Service Physicians Organisation, DK-1112 Copenhagen, Denmark, ^c Institute of Cancer Epidemiology, Danish Cancer Society, Box 839, DK-2100 Copenhagen, Denmark, ^d Department of Growth and Reproduction, National University Hospital, DK-2100 Copenhagen, Denmark, ^e Thames Cancer Registry, Guy's, King's, and St Thomas' School of Medicine, London SE1 3QD

Correspondence to: Rune Jacobsen, Department of Epidemiology, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Panum Institute, DK-2200 Copenhagen, Denmark R.jacobsen{at}pubhealth.ku.dk

Objective: To explore the associations between semen characteristics and subsequent risk of testicular cancer.
Design: Cohort study.
Participants: 32 442 men who had a semen analysis done at the Sperm Analysis Laboratory in Copenhagen during 1963-95.
Main outcome measure: Standardised incidence ratios of testicular cancer compared with total population of Danish men.
Results: Men in couples with fertility problems were more likely to develop testicular cancer than other men (89 cases, standardised incidence ratio 1.6; 95% confidence interval 1.3 to 1.9). The risk was relatively constant with increasing time between semen analysis and cancer diagnosis. Analysis according to specific semen characteristics showed that low semen concentration (standardised incidence ratio 2.3), poor motility of the spermatozoa (2.5), and high proportion of morphologically abnormal spermatozoa (3.0) were all associated with an increased risk of testicular cancer. The only other cancer group that showed increased incidence was "peritoneum and other digestive organs" (six cases; 3.7, 1.3 to 8.0). Of these, two cases were probably and two cases were possibly extragonadal germ cell tumours.
Conclusions: The results point towards the existence of common aetiological factors for low semen quality and testicular cancer. Low semen quality may also be associated with increased incidence of extragonadal germ cell tumours.

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