Brrrith Joitnialof Urolog.v(I979).51. 151-153

Tumours of Testis in Jamaica A.

B. RAO and B. SPARKE

Departments of Surgery and Pathology, University of the West lndies, Kingston, Jamaica

Summary-Malignant tumours of the testis are reported t o be rare in negroes. All cases reported in the records of the University Hospital of the West lndies and the Jamaica Cancer Registry over the period June 1 9 5 8 t o December 1 9 7 6 were studied. There were 2 6 cases, giving a world standardised incidence of 0.40 per 100,000 per year. This incidence is higher than that seen in African negroes but lower than that of negroes in North America. The peak age incidence is a decade later than that commonly seen in high incidence countries.

Tumours of the testis are uncommon malignant conditions with a varying incidence in different countries (Pugh, 1976). They are rare in negro populations (Prates and Torres, 1965). This study reports the incidence of these tumours in Jamaica, which has a predominantly negro population, and compares the findings with previously reported studies in Africa and America.

Pa tients Twenty-six cases of tumours of the testis were reviewed over a 19-year period, June 1958 to June 1977. Twelve of the cases from Kingston and St Andrew district (male population 244,423) appeared in the Jamaica Cancer Registry. The remainder were from the rest of the island (male population 364,100). Twenty-one case histories were available for examination and histological review. Two cases did not have histological confirmation of the diagnosis and have been excluded from our study. In 3 cases histological slides were not available for review. Twenty-three of the patients were negroes and one was Chinese. Results From 1958 to 1974 there was a comparatively regular presentation of one case each year. Then in 1975 and 1976 there were 6 and 4 cases respectively (Table 1). Received 13 January 1978. Accepted for publication 1 I July 1978.

Ten patients were in the 30 to 50 age group and 7 were over the age of 60 years (Fig.). In all but one of the patients the presenting symptom was swelling of the testis. In one patient the tumour occurred in an undescended intraabdominal testis. The right and left testes were equally affected and there was one case of bilateral tumour. There was a 5-day to 6-week delay between the onset of symptoms and diagnosis and two-thirds of the cases had regional node involvement or distant metastases at the time of presentation. The histological types of these testicular tumours were: seminoma (1 3); embryonic carcinoma ( 5 ) ; teratoma (I); Leydig cell (1); lymphosarcoma (I). The patients were treated on conventional lines by orchiectomy followed by radiotherapy. Discussion

The assessment of the incidence of the disease Table 1 Incidence of Turnours of Testis in Jamaica June 1958-June 1977 Year

No. of cases

June-June

Histologically proved

1958-1963

6

Total Histologically not proved

-

No. of cases

6

1963-1968

6

1

7

1968-1973

2

-

2

1973-1977

10

1

II

Total

24

2

26

151

BRITISH JOURNAL. OF UROLOGY

152

0

10

20

30

40

50

60+

Age in years Fig. Age incidence of cancer of the testis in Jamaica.

must take into account the inherent problems of accuracy of diagnosis and notification, and in Jamaica there are sometimes problems in seeking and obtaining medical treatment. I f the findings are restricted to the well documented part of the population covered by the Jamaica Cancer Registry (Kingston and St Andrew district), then the crude incidence of testicular tumours was 0.26 per 100,000 per year. This is in accord with the generally accepted low incidence in negro populations. Oettle (1964) reported 7 histologically confirmed cases in 2 million Bantu aged 15 to 54 years, during a 5-year period (1949 to 1953): in the same period, in contrast, he found 22 testicular tumours among 600,000 whites in the same age group. Davies el al. (1964), reporting from Uganda, found only 3 cases of testicular tumours for the period 1897 to 1956. Edington and Maclean (1965) reported 6 cases from Ibadan during the period 1960 to 1963. No testicular tumours were reported by Prates and Torres (1965) in Lourenco Marques, Portuguese East Africa, during the 5year period 1956 to 1961. Tulinius et al. (1973), comparing different populations, found that testicular tumour occurred 20 times more frequently in whites than in negroes, whereas the USA National Cancer Institute found a negro: white ratio of 1 :3. When we compare the Jamaican figures with those reported for African populations, after the necessary adjustments for age variation between

different populations (Doll et al., 1966), we have a Jamaican incidence of 0.33 per lo00 males per year when corrected for the African population and 0.4 when corrected for the world population. Although this incidence is still low, this is higher than that reported in Africa despite the predominantly negro population in Jamaica (Table 2). The peak age incidence of testicular neoplasia in Jamaica (Fig.) is earlier than that in North American negroes, in whom it is more commonly seen in the sixth decade (Grumet and MacMahon, 1958). However, it is of interest that our peak age incidence at 30 to 50 years is a decade later than that seen in high incidence countries (Clemmesen, 1 969). The relative importance of environmental or hereditary factors in the aetiology of testicular tumours is difficult to assess. I t has been suggested that a high scrotal temperature may be a factor (Clemmesen, 1969). In Jamaica, a tropical country with a Westernised clothing habit, it could be postulated that the scrotal temperature Age-adjusted Annual Incidence Rates of Malignant Testicular Turnours per 100,OOO Males in Certain Countries and Districts in the Early 1960s (Adjusted to World Standard Population). (Taken from Teppo, 1973)

Table 2

Country or disrricr

Incidence rate

Denmark Federal Republic of Germany (Hamburg) Norway New Zealand (Maori) Canada (Saskatchewan) USA (Alameda, white) South Africa (Cape Province, white) Scotland Sweden England (Sheffield) Colombia (Cali) Hungary (Miskolc) Yugoslavia (Slovenia) Israel Japan (Okayama) Canada (Quebec) Hungary (Szabolcs, Szatmar) Poland (Cracow) Romania (Banat) Finland India (Bombay) South Africa (Cape Province, coloured) Puerto Rico Nigeria (Ibadan) South Africa (Cape Province, Bantu) USA (Alameda, negro)

4.5 4.0 3.6

3.4 3.3 3. I 2.6 2.5 2.2 2.1 2.0 I .7

I .6 I .5 I .2 1.1

1 .o 1 .o I .o 0.9 0.9 0.9 0.7 0.1

-

-

153

T U M O U R S OF TESTIS IN J A M A I C A

might be higher than that of African negroes. This may have contributed to our higher incidence. The marked increase in the incidence of testicular tumour in 1975 and 1976 is difficult to explain. Testicular tumour has been correlated with tumours of “affluence” such as colonic carcinoma (Berg et al., 1973) in which the environment is suspect as a causative factor. Carcinoma of the colon is common in Jamaica, ranking sixth in order of incidence of malignant tumours in males (Persaud, 1976), contrasting with a very low incidence in Nigeria. While the incidence of testicular neoplasia is slightly higher in Jamaica, accounting for 0.3% of all male cancer (Persaud, 1976), it remains low in both countries. A disturbing feature of this study is the delay in diagnosis, with the result that two-thirds of the patients had regional or distant metastases at the time of operation. One factor in late diagnosis may be the generally accepted view that these tumours are’uncommon in negroes. We conclude that a greater awareness of the true incidence of these tumours in negroes might lead to earlier recognition.

Acknowledgements Thc authors would like to acknowledge the assistance given by the Jamaica Cancer Registry, by the Departments of Pathology in the University Hospital of the West lndies and Kingston Public Hospital, and by our colleagues. Wc would also like to thank Dr R. C . 13. Pugh for advice.

Clemmesen, J. (1969). Statistical studies in the Aetiology of Malignant neoplasms. I 1 I. Testis Cancer Basic Tables. Acta pathologica el microbiologica Scandinavica. Supplement 209, 15-41. Davies. J. N., Elmes, S., Hutt, M. R., Mtimvalye, L. R., Owor, R. and Shaper, L. (1964). Cancer in African Community 1897-1956. British Medical Journal, 1, 259-264. Doll, R., Payne, P. and Waterhouse, J. (1966). Cancer Incidence in Five Continents: a Technical Report. Volume 1. Distributed for the International Union against Cancer

by Springer-Verlag. Edinglon, C. M. and Maclean, C. M. (1965). A cancer rate survey in Ibadan, Western Nigeria, 1963. British Journal of Cancer, 29, 47 1-48 1 .

Crumet, R. E. and MacMahon, B. (1958). Trends in mortality from neoplasms of the testis. Cancer (Philadelphia). 11, 790-797.

Oettle, A. G. (1964). Tumours of testis in South Africa. Leech (Johannesburg), 34, 142- 148.

Persaud, V. (1976). Cancer incidence in Jamaica: an 18 year analysis (1958-1975). West Indian Medical Journal. 25, 201-2 15. Prates, D. M. and Torres, F. 0. (1965). A cancer survey in Lourenco Marques, Portuguese East Africa. Journal oJ the National Cancer Institute. 35, 729-757.

Pugh, R. C. B. (1976). Pathology of the Testis. p. 142. Oxford: Blackwell Scientific Publications. Teppo, L. (1973). Testicular Cancer in Finland. Acra parhologica el microbiologica Scandinavica, Supplement 238, 41. Tulinius, H., Day, N. and Muir, C. S. (1973). Rarity of testis cancer in Negroes. Lancet, I , 35-36.

The Authors A . Bhaskar Rao, MB, FRCS, Lecturer in Surgery.

Brian Sparke, MB, DCP, Lecturer in Pathology.

References Berg, J. W.. Goodwin 11, J. D.. McBay, W. F. and Percy, L. (1973). Testis Cancer in Negroes. Lancet, I, 782-783.

Requests for reprints to: A. Bhaskar Rao, Department of Surgery, University of the West Indies. Kingston 7, Jamaica.

Tumours of the testis in Jamaica.

Brrrith Joitnialof Urolog.v(I979).51. 151-153 Tumours of Testis in Jamaica A. B. RAO and B. SPARKE Departments of Surgery and Pathology, University...
203KB Sizes 0 Downloads 0 Views