Skip to main content
SpringerLink
Log in

Is increased body mass index associated with the incidence of testicular germ cell cancer?

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Epidemiological and ecological evidences suggest a positive association of overweight and obesity with the risk of testicular germ cell cancer (GCC). Previous controlled trials reported conflicting results. The present study aimed to analyse the putative association of overweight with GCC risk in a large patient sample and to summarize previous data.

Methods

A total of 8,498 GCC patients were enrolled in a nationwide multicentric case control study. Self-reported body dimensions were recorded for calculation of the body mass index (BMI; kg/m2). For comparison, 2,070 age-matched male probands of the latest German National Health Survey (NHS) were employed. Patients and controls were categorized according to age as follows: 18–29, 30–39, and 40–49 years, respectively, and according to BMI, as follows: <18.5; 18.5 to <25; 25 to <30; >30 kg/m2, respectively. Frequencies of BMI-categories in the three age groups were tabulated and compared statistically. The literature was searched for previous controlled trials regarding BMI and GCC risk.

Results

The median BMI of all GCC patients is 24.69 kg/m2. Overall comparison of frequencies of BMI categories of cases and controls did not reveal any significant difference. However, in young men (18–29 years) BMI categories 25 to <30 kg/m2 and >30 kg/m2 were significantly more frequent in GCC patients than in controls (p < 0.00001). Nineteen previous studies were identified in the literature, one of which being clearly in accordance with the present hypothesis, one being antithetical while the remaining studies were inconclusive in various aspects.

Conclusion

The results of this population-based study lend support to two hypotheses regarding the pathogenesis of GCC: First, as high-calorie nutrition is the most important reason for increased BMI, it appears conceivable that nutritional factors are involved in the pathogenesis of GCC. Second, as nonseminoma is the most prevalent histological subtype among younger patients, the association of increased BMI with incidence of GCC in this particular subgroup may point to divergent pathogenetic pathways of nonseminoma and seminoma, respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akre O, Ekbom A, Sparen P, Tretli S (2000) Body size and testicular cancer. J Natl Cancer Inst 92:1093–1096. doi:10.1093/jnci/92.13.1093

    Article  PubMed  CAS  Google Scholar 

  • Armstrong B, Doll R (1975) Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 15:617–631. doi:10.1002/ijc.2910150411

    Article  PubMed  CAS  Google Scholar 

  • Aschim EL, Haugen TB, Tretli S, Daltveit AK, Grotmol T (2006) Risk factors for testicular cancer–differences between pure non-seminoma and mixed seminoma/non-seminoma? Int J Androl 29:458–467. doi:10.1111/j.1365-2605.2005.00632.x

    Article  PubMed  CAS  Google Scholar 

  • Bianchini F, Kaaks R, Vainio H (2002) Overweight, obesity, and cancer risk. Lancet Oncol 3:565–574. doi:10.1016/S1470-2045(02)00849-5

    Article  PubMed  Google Scholar 

  • Bjørge T, Tretli S, Lie AK, Engeland A (2006) The impact of height and body mass index on the risk of testicular cancer in 600,000 Norwegian men. Cancer Causes Control 17:983–987. doi:10.1007/s10552-006-0032-8

    Article  PubMed  Google Scholar 

  • Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348:1625–1638. doi:10.1056/NEJMoa021423

    Article  PubMed  Google Scholar 

  • Coupland CA, Chilvers CE, Davey G, Pike MC, Oliver RT, Forman D (1999) Risk factors for testicular germ cell tumours by histological tumour type United Kingdom Testicular Cancer Study Group. Br J Cancer 80:1859–1863. doi:10.1038/sj.bjc.6690611

    Article  PubMed  CAS  Google Scholar 

  • Davies TW, Prener A, Engholm G (1990) Body size and cancer of the testis. Acta Oncol 29:287–290. doi:10.3109/02841869009089999

    Article  PubMed  CAS  Google Scholar 

  • Dieckmann KP (2007) Pre- and paraclinical cooperative trials on testicular cancer: background and overview of current trials (in German). Urologe A 46:1180–1184. doi:10.1007/s00120-007-1399-1

    Article  PubMed  Google Scholar 

  • Dieckmann KP, Skakkebaek NE (1999) Carcinoma in situ of the testis: a review of biological and clinical features. Int J Cancer 83:815–822. doi:10.1002/(SICI)1097-0215(19991210)83:6<815::AID-IJC21>3.0.CO;2-Z

    Article  PubMed  CAS  Google Scholar 

  • Dieckmann KP, Pichlmeier U (2002) Is risk of testicular cancer related to body size? Eur Urol 42:564–569. doi:10.1016/S0302-2838(02)00467-0

    Article  PubMed  Google Scholar 

  • Dieckmann KP, Pichlmeier U (2004) Clinical epidemiology of testicular germ cell tumors. World J Urol 22:2–14. doi:10.1007/s00345-004-0398-8

    Article  PubMed  Google Scholar 

  • Dieckmann KP, Hartmann JT, Classen J, Lüdde R, Diederichs M, Pichlmeier U (2008) Tallness is associated with risk of testicular cancer: evidence for the nutrition hypothesis. Br J Cancer Sep 30. (Epub ahead of print). doi:10.1038/sj.bjc.6604695

  • Ellert U, Wirz J, Ziese T (2006) Telefonischer Gesundheitssurvey des Robert Koch-Institutes (2.Welle). Deskriptiver Ergebnisbericht. Robert Koch Institut, Berlin

    Google Scholar 

  • Gallagher RP, Huchcroft S, Phillips N, Hill GB, Coldman AJ, Coppin C, Lee T (1995) Physical activity, medical history, and risk of testicular cancer (Alberta and British Columbia, Canada). Cancer Causes Control 6:398–406. doi:10.1007/BF00052179

    Article  PubMed  CAS  Google Scholar 

  • Ganmaa D, Li XM, Wang J, Qin LQ, Wang PY, Sato A (2002) Incidence and mortality of testicular and prostatic cancers in relation to world dietary practices. Int J Cancer 98:262–267. doi:10.1002/ijc.10185

    Article  PubMed  CAS  Google Scholar 

  • Garner MJ, Birkett NJ, Johnson KC, Shatenstein B, Ghadirian P, Krewski D (2003) Dietary risk factors for testicular carcinoma. Int J Cancer 106:934–941. doi:10.1002/ijc.11327

    Article  PubMed  CAS  Google Scholar 

  • Hardell L, Bavel B, Lindstrom G, Eriksson M, Carlberg M (2006) In utero exposure to persistent organic pollutants in relation to testicular cancer risk. Int J Androl 29:228–234. doi:10.1111/j.1365-2605.2005.00622.x

    Article  PubMed  CAS  Google Scholar 

  • Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:2847–2850. doi:10.1001/jama.291.23.2847

    Article  PubMed  CAS  Google Scholar 

  • Holmes LJ, Escalante C, Garrison O, Foldi BX, Ogungbade GO, Essien EJ, Ward D (2008) Testicular cancer incidence trends in the USA (1975–2004): plateau or shifting racial paradigm? Public Health 122:862–872. doi:10.1016/j.puhe.2007.10.010

    Article  PubMed  Google Scholar 

  • Horwich A (1996) Testicular germ cell tumors: An introductory overview. In: Horwich A (ed) Testicular cancer. Investigation and management, 2nd edn. Chapman & Hall, London, pp 1–18

    Google Scholar 

  • Huddart RA, Norman A (2003) Changes in BMI after treatment of testicular cancer are due to age and hormonal function and not chemotherapy. Br J Cancer 89:1143–1144. doi:10.1038/sj.bjc.6601178

    Article  PubMed  CAS  Google Scholar 

  • Huyghe E, Plante P, Thonneau PF (2007) Testicular cancer variations in time and space in Europe. Eur Urol 51:621–628. doi:10.1016/j.eururo.2006.08.024

    Article  PubMed  Google Scholar 

  • James WP, Ralph A (1999) New understanding in obesity research. Proc Nutr Soc 58:385–393

    PubMed  CAS  Google Scholar 

  • Kleinteich B, Marx G (1983) Sind große schlanke Männer für Hodenkarzinome disponiert? Med Akt 9:146

    Google Scholar 

  • Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia Del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H (2008) European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I. Eur Urol 53:478–496. doi:10.1016/j.eururo.2007.12.024

    Article  PubMed  Google Scholar 

  • Lin RS, Kessler II (1979) Epidemiologic findings in testicular cancer. Am J Epidemiol 110:357

    Google Scholar 

  • McGlynn KA, Devesa SS, Graubard BI, Castle PE (2005) Increasing incidence of testicular germ cell tumors among black men in the United States. J Clin Oncol 23:5757–5761. doi:10.1200/JCO.2005.08.227

    Article  PubMed  Google Scholar 

  • McGlynn KA, Sakoda LC, Rubertone MV, Sesterhenn IA, Lyu C, Graubard BI, Erickson RL (2007) Body size, dairy consumption, puberty, and risk of testicular germ cell tumors. Am J Epidemiol 165:355–363. doi:10.1093/aje/kwk019

    Article  PubMed  Google Scholar 

  • Mensink GBM, Lampert T, Bergmann E (2005) Overweight and obesity in Germany 1984–2003. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 48:1348–1356. doi:10.1007/s00103-005-1163-x

    Article  PubMed  CAS  Google Scholar 

  • Mikuz G, Colecchia M (2007) Tumors of the testis and paratesticular structures. In: Mikuz G (ed) Clinical pathology of urologic tumors. Informa Healthcare, London, pp 161–214

    Google Scholar 

  • Nord C, Fossa SD, Egeland T (2003) Excessive annual BMI increase after chemotherapy among young survivors of testicular cancer. Br J Cancer 88:36–41. doi:10.1038/sj.bjc.6600714

    Article  PubMed  CAS  Google Scholar 

  • Nuver J, Smit AJ, Wolffenbuttel BH, Sluiter WJ, Hoekstra HJ, Sleijfer DT, Gietema JA (2005) The metabolic syndrome and disturbances in hormone levels in long-term survivors of disseminated testicular cancer. J Clin Oncol 23:3718–3725. doi:10.1200/JCO.2005.02.176

    Article  PubMed  CAS  Google Scholar 

  • Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555. doi:10.1001/jama.295.13.1549

    Article  PubMed  CAS  Google Scholar 

  • Ogden CL, Yanovski SZ, Carroll MD, Flegal KM (2007) The epidemiology of obesity. Gastroenterology 132:2087–2102. doi:10.1053/j.gastro.2007.03.052

    Article  PubMed  Google Scholar 

  • Oosterhuis JW, Looijenga LH (2005) Testicular germ-cell tumours in a broader perspective. Nat Rev Cancer 5:210–222. doi:10.1038/nrc1568

    Article  PubMed  CAS  Google Scholar 

  • Pan SY, Johnson KC, Ugnat AM, Wen SW, Mao Y, CCRER Group (2004) Association of obesity and cancer risk in Canada. Am J Epidemiol 159:259–268. doi:10.1093/aje/kwh041

    Article  PubMed  Google Scholar 

  • Petridou E, Roukas KI, Dessypris N, Aravantinos G, Bafaloukos D, Efraimidis A, Papacharalambous A, Pektasidis D, Rigatos G, Trichopoulos D (1997) Baldness and other correlates of sex hormones in relation to testicular cancer. Int J Cancer 71:982–985. doi:10.1002/(SICI)1097-0215(19970611)71:6<982::AID-IJC13>3.0.CO;2-8

    Article  PubMed  CAS  Google Scholar 

  • Pischon T, Nöthlings U, Boeing H (2008) Obesity and cancer. Proc Nutr Soc 67:128–145. doi:10.1017/S0029665108006976

    Article  PubMed  Google Scholar 

  • Purdue MP, Devesa SS, Sigurdson AJ, McGlynn KA (2005) International patterns and trends in testis cancer incidence. Int J Cancer 115:822–827. doi:10.1002/ijc.20931

    Article  PubMed  CAS  Google Scholar 

  • Rasmussen F, Gunnell D, Ekbom A, Hallqvist J, Tynelius P (2003) Birth weight, adult height, and testicular cancer: cohort study of 337,249 Swedish young men. Cancer Causes Control 14:595–598. doi:10.1023/A:1024860826830

    Article  PubMed  Google Scholar 

  • Ravelli GP, Stein ZA, Susser MW (1976) Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 295:349–353

    PubMed  CAS  Google Scholar 

  • Renehan AG, Roberts DL, Dive C (2008) Obesity and cancer: Pathophysiological and biological mechanisms. Arch Physiol Biochem 114:71–83. doi:10.1080/13813450801954303

    Article  PubMed  CAS  Google Scholar 

  • Richiardi L, Askling J, Granath F, Akre O (2003) Body size at birth and adulthood and the risk for germ-cell testicular cancer. Cancer Epidemiol Biomarkers Prev 12:669–673

    PubMed  Google Scholar 

  • Richiardi L, Pettersson A, Akre O (2007) Genetic and environmental risk factors for testicular cancer. Int J Androl 30:230–240. doi:10.1111/j.1365-2605.2007.00760.x

    Article  PubMed  Google Scholar 

  • Roseboom T, de Rooij S, Painter R (2006) The Dutch famine and its long-term consequences for adult health. Early Hum Dev 82:485–491. doi:10.1016/j.earlhumdev.2006.07.001

    Article  PubMed  Google Scholar 

  • Sagstuen H, Aass N, Fossa SD, Dahl O, Klepp O, Wist EA, Wilsgaard T, Bremnes RM (2005) Blood pressure and body mass index in long-term survivors of testicular cancer. J Clin Oncol 23:4980–4990. doi:10.1200/JCO.2005.06.882

    Article  PubMed  CAS  Google Scholar 

  • Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JFJ (2006) Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes Control 17:901–909. doi:10.1007/s10552-006-0023-9

    Article  PubMed  Google Scholar 

  • Srivastava A, Kreiger N (2000) Relation of physical activity to risk of testicular cancer. Am J Epidemiol 151:78–87

    PubMed  CAS  Google Scholar 

  • Stang A, Ahrens W, Baumgardt-Elms C, Stegmaier C, Merzenich H, de Vrese M, Schrezenmeir J, Jockel KH (2006) Adolescent milk fat and galactose consumption and testicular germ cell cancer. Cancer Epidemiol Biomarkers Prev 15:2189–2195. doi:10.1158/1055-9965.EPI-06-0372

    Article  PubMed  CAS  Google Scholar 

  • Swerdlow AJ, Huttly SRA, Smith PG (1989) Testis cancer: post-natal hormonal factors, sexual behaviour and fertility. Int J Cancer 43:549–553. doi:10.1002/ijc.2910430403

    Article  PubMed  CAS  Google Scholar 

  • Thefeld W, Stolzenburg H, Bellach B-M (1999) German national health interview and examination survey: Presponse, composition of participants, and analysis of non-responders. Gesundheitswesen 61(Suppl 2):S57–S61

    PubMed  Google Scholar 

  • Thorling EB (1996) Obesity, fat intake, energy balance, exercise and cancer risk. A review Nutr Res 16:315–368. doi:10.1016/0271-5317(96)00015-2

    Google Scholar 

  • Thune I, Lund E (1994) Physical activity and the risk of prostate and testicular cancer: a cohort study of 53,000 Norwegian men. Cancer Causes Control 5:549–556. doi:10.1007/BF01831383

    Article  PubMed  CAS  Google Scholar 

  • UK Testicular Cancer Study Group (1994) Aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility, and exercise. BMJ 308:1393–1399

    Google Scholar 

  • Walcott FL, Hauptmann M, Duphorne CM, Pillow PC, Strom SS, Sigurdson AJ (2002) A case-control study of dietary phytoestrogens and testicular cancer risk. Nutr Cancer 44:44–51. doi:10.1207/S15327914NC441_6

    Article  PubMed  CAS  Google Scholar 

  • Weisburger JH (1997) Dietary fat and risk of chronic disease: mechanistic insights from experimental studies. J Am Diet Assoc 97(7 Suppl):S16–S23. doi:10.1016/S0002-8223(97)00725-6

    Article  PubMed  CAS  Google Scholar 

  • Willet WC (2006) Diet and Nutrition. In: Schottenfeld D, Fraumeni JFj (eds) Cancer epidemiology and prevention, 3rd edn. Oxford University Press, New York, pp 405–421

    Google Scholar 

Download references

Acknowledgments

The authors are grateful for support of this study by Vereinigung Norddeutscher Urologen and Soldatentumorhilfe Hamburg.

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Klinik für Urologie, Albertinen-Krankenhaus, Suentelstrasse 11a, 22457, Hamburg, Germany

    Klaus-Peter Dieckmann & Malte Diederichs

  2. Klinik für Onkologie und Hämatologie, Universitätsklinik Tübingen, Tübingen, Germany

    Jörg Thomas Hartmann

  3. Institut für Radioonkologie, St. Vincentius Kliniken, Karlsruhe, Germany

    Johannes Classen

  4. Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Eppendorf, Hamburg, Germany

    Uwe Pichlmeier

Authors
  1. Klaus-Peter Dieckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jörg Thomas Hartmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johannes Classen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Malte Diederichs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Uwe Pichlmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Klaus-Peter Dieckmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dieckmann, KP., Hartmann, J.T., Classen, J. et al. Is increased body mass index associated with the incidence of testicular germ cell cancer?. J Cancer Res Clin Oncol 135, 731–738 (2009). https://doi.org/10.1007/s00432-008-0504-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-008-0504-1

Keywords

Search

Navigation