Mortality and incidence of second cancers following treatment for testicular cancer.

[Karen]

Br J Cancer. 2007 Jan 30;
Mortality and incidence of second cancers following treatment for testicular cancer.Robinson D, Moller H, Horwich A.
1King's College London, Thames Cancer Registry, London SE1 3QD, UK.

We studied 5555 seminoma patients and 3733 patients with nonseminomatous testicular cancers diagnosed in Southeast England between 1960 and 2004. For both groups survival improved over time: 10-year relative survival increased from 78% in 1960-1969 to 99% in 1990-2004 for seminomas, and from 55 to 95% for nonseminomas. In the early period mortality was still significantly increased more than 15 years after diagnosis in both groups, whereas in more recent periods the excess deaths mainly occurred in the first 5 years after diagnosis. For seminomas, there was a significant excess of cancers of the colon (standardised incidence ratio (SIR) 2.36; 95% confidence interval (CI) 1.13-4.35), soft tissue (SIR 13.64; CI 1.65-49.28) and bladder (SIR 4.28; CI 2.28-7.31) in the long term (20+ years after diagnosis), of pancreatic cancer in both the medium (10-19 years) (SIR 2.91; CI 1.26-5.73) and long term (SIR 5.48; CI 2.37-10.80), of leukaemia in both the short (0-9 years) (SIR 3.01; CI 1.44-5.54) and long term (SIR 4.48; CI 1.64-9.75), and of testis cancer in both the short (SIR 6.69; CI 4.28-9.95) and medium term (SIR 3.96; CI 1.08-10.14). For nonseminomas, significant excesses were found in the long term for cancers of the stomach (SIR 5.13; CI 1.40-13.13), rectum (SIR 4.49; CI 1.22-11.51) and pancreas (SIR 10.17: CI 3.73-22.13), and for testis cancer in the medium term (SIR 5.94; CI 2.18-12.93). Leukaemia was significantly increased in the short term (SIR 6.78; CI 2.93-13.36). The better survival observed is largely attributable to improved treatment, and the trend in reducing the toxicity of therapy should continue to reduce future health risks in testicular cancer survivors.British Journal of Cancer advance online publication, 30 January 2007; doi:10.1038/sj.bjc.6603589 www.bjcancer.com.

PMID: 17262080 [PubMed - as supplied by publisher]

[Eric]

I would like to verify if i understand well all these statistics

According to statistic canada

Here are some odds of cancer for men from 40 to 50 years old

All cancer 1,6%
Prostatic 0,1%
Lung 0,2%
Colon 0,2%
Lymphoma 0,2%
bladder 0,1%
mouth 0,1%
Kidney 0,1%
stomach 0,1%
Leukemia 0,1%
Pancreatic 0,0%
Melanoma 0,1%

So now i take for exemple the odds for colon cancer(X 2.36for seminoma) =0.472%

So my new odds are

Prostatic 0.1% unchanged
Lung 0.2% unchanged
colon 0.47%
lymphoma 0.2% unchanged
bladder 0.43%
mouth 0.1% unchanged
kidney 0.1% unchanged
stomach 0.1% unchanged but not so sure for this one
leukemia 0.3%
pancreatic 0.0%
melanoma 0.1%
All cancer 2.5%

I also have to add my odds of recurence

Is it the right way to estimate the odds?

[jder4]

No offense on this, but I look at this and shake my head. I realize it is important to have some knowledge as to what may or may not happen down the line. Unfortunatley, my husband just blew those statistics right out of the water. I am Mark's wife (or as he is known here as TCLEFT). After having a clean PET scan this past July 2006, he relapsed this January 2007.
Our battle is just beginning. I apologize for sounding angry but why do we dwell on what may or may not happen? Isn't it more important to try to be positive and just do all that you can to be healthy and support one another when all goes wrong?

[Scott]

I don't blame you a bit for being angry. I'm ticked off at cancer, too. I hope you and Mark know how much we care and are rooting for you both.

[Karen]

jder4,
I alway try to look carefully at articles I post and never want to upset anyone but want to put things out for those that want to keep up with the literature...for better or worse. We all know that there are risks from the treatments, chemo or radiation, but the risk of not doing anything at all makes treatment essential in most cases. Because the risk is statisticaly significant doesn't mean it has gone from a tiny to a HUGE incidence. The increased risks are still relatively low, especially considering that women have ~12% chance of breast cancer during our lifetime. The take home message I had from this is that overall health needs to be monitored...complete physicals and not just the TC follow ups. Also, I highlighted the good news...treatment has improved, toxicity has been decreasing, and hopefully in another generation TC will be even more survivable with less risk in treatment. My husband had RT, and because of the increased colon cancer risk he needs to be proactive with colonoscopies.
Mark's recurrance has a lot of us here angry at this disease. He is in our hearts, and we are sending only positive, strong thoughts to you both, and your kids.

[Eric]

Everytime i look at the posts in this section it makes me upset. I try to associate numbers to everything in my life, it probably comes from my formation(i am an engineer). I always try to turn statistics on a less negative way. That's why i have answered to this one. I am really sorry if my post or karen's post has hurt you jder4 . Like you said it's better to stay positve and that's what i am trying to do but it's impossible for me to stay positive 24 hours every day. There is a place in my mind for what i've gone throught and i feel like i have my guard up to avoid a future disease. I pray for your husband everyday and i am sure that he will beat this. Seminoma is highly chemosensitive.

[mstlyn]

What does all of this mean? Are we saying that the chances of absolute cure are not what they are made out to be?
Sounds more like remissions than cures that are going on here!
I prefer knowing what to expect, rather than thinking everything is going to be ok when the odds are that things won't be ok!
If someone can break these statistics down I would appreciate it.

[Scott]

What does all of this mean? Are we saying that the chances of absolute cure are not what they are made out to be?
Sounds more like remissions than cures that are going on here!

I wouldn't say that. However, chemotherapy and radiation therapy -- and even just having had cancer before -- increase the chances of getting a second cancer.

[djmac]

What does all of this mean? Are we saying that the chances of absolute cure are not what they are made out to be?
Sounds more like remissions than cures that are going on here!
I prefer knowing what to expect, rather than thinking everything is going to be ok when the odds are that things won't be ok!
If someone can break these statistics down I would appreciate it.

Hi mstlyn,

While this forum has lots of people who are in fact cured, I would say that there are probably more such people in the general population. This forum probably has a higher percentage of people with recurrances than in the general population because such people are more likely to use the forum. This can give you a slightly negative skew on prognosis.

Does this make sense?

[dadmo]

I agree that the population using this forum will skew toward the negative we still need to be aware of haw bad chemo or radiation are. That's why chemo and radiation should only be used when absolutely necessary. These are not prophylactic treatments. The cure can be devistating.

[Mom]

No question, you have to be vigilant. My husband ended up with bladder cancer 15 years after TC. He didn't have chemo or radiation for treating his TC, just the RPLND. However, the first sign that there was a problem (blood in his urine) the urologist didn't miss a beat and he was tested and operated on within the week. He has had two reoccurrences of bladder cancer but it is controllable. He has been on TRT for 27 years, it is controllable. Its the price for staying alive and living a near normal life. Someone quoted this on the forum "You must abandon the life you planned to live the life that was meant for you." I never believed in fate because I thought you could control your own destiny. I don't know what to believe anymore. I do know that sh*t happens. My brother was killed in a parking lot walking into a resturant while on vacation. Dead, instantly, just like that. When my son was diagnosed with TC and I was upset, my husband asked if I would have rather gotten that call. Where there is life there is hope. Fight for it! Dianne

[Karen]

Where there is life there is hope. Fight for it! Dianne

Absolutely. We've all learned the hard way that plans and dreams can be disrupted in a heartbeat. We just have to pick up the rhythm again, adjust our dreams, and go forward.

Dianne, I'm so sorry about your brother.

[Sans rt1]

I think this is a very valuable discussion - it really helps put things into perspective for me.

Like Eric, I am an engineer, and have many times sat and ran the mumbers through my head trying to come up with what my overall risk looks like. But what good is that? What does it really change? What happens will happen, no matter what I have calculated.

So I guess we need to remember that life is uncertain and there are no guarantees - that goes for not just us survivors, but for everyone - it is just that we probably realize it more based on what we have been through.

So, be vigilant but don't dwell on the uncertainty, instead live each day to the fullest and appreciate those you love while you can. Great advice. I just wish it was as easy to do as it is to write the words.

[Eric]

What does it really change?

I think that knowing our risk allow us to be proactive to prevent another disease. For example if i see that i am at 2% for a colon cancer and the normal is 1%. I can try to change my way of life, like drinking less beer, and eating more vegetables and fruits. It is now scientificaly prooved that if you replace beer by red wine( 1 glass/day ) your lowering your risks. When we know our risk we are more likely to go for early detection tests. I plan to go for a colonoscopy in a few months. Contrary to the others this thread brought many comments

[Sans rt1]

Eric - -

Good point.

What I was going for was that we should not dwell on the what-ifs of what fate and our treatments have left us with. Worrying and dwelling on what might happen has a negative affect on your physical and mental health and keeps you from fully enjoying life - and from what I have read on this Forum some folks do worry excessively about it. It is something we all have to come to terms with, but for me, a 1% vs. 2% does not matter all that much - yes it is double, but it is still very low. You can do everything right and still be in the 1 or 2%.

Consider this - I had about a 1 in 300 chance of getting TC - pretty good odds overall, but guess what? One day my son throws me a baseball and I miss catching it - and because of where it hit me I notice something isn't right - and in a very short amount of time my odds go from 0.33% to 100% chance. At the same time I am unlucky to have TC, but extremely lucky to have found it early - and extremely lucky to have a cancer that is so treatable. That is how fate works.

There are little things we can all do to improve our health overall, and I guess if knowing you are 2% vs. 1% gets you to make those changes, or go to the doctor on a regular schedule, then it is an extremely valuable exercise.