Risk Factors for Testicular Cancer

Scientists have found a few risk factors that make someone more likely to develop testicular cancer.

A risk factor is anything that changes your chance of getting a disease, such as cancer. Different cancers have different risk factors. Some risk factors, like smoking and diet, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many, does not mean that you will get the disease.

Undescended testicle

One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This means that one or both testicles fail to move from the abdomen (belly) into the scrotum before birth. Males with cryptorchidism are many times more likely to get testicular cancer than those with normally descended testicles.

Normally, the testicles develop inside the abdomen of the fetus, and they go down (descend) into the scrotum before birth. But in about 3% of boys, the testicles do not make it all the way down before the child is born. Sometimes, one or both testicles stay in the abdomen. In other cases, the testicles start to descend but stay in the groin area.

Most of the time, undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle hasn't descended by the time a child is a year old, it probably isn’t going to do it on its own. Sometimes a surgical procedure known as orchiopexy is needed to move the testicle down into the scrotum.

The risk of testicular cancer might be a little higher for men whose testicle stayed in the abdomen as opposed to one that has descended at least partway. If cancer does develop, it's usually in the undescended testicle, but about 1 in 4 cases occur in the normally descended testicle. Because of this, some doctors conclude that cryptorchidism doesn’t actually cause testicular cancer, but that there's something else that leads to both testicular cancer and abnormal positioning of one or both testicles.

Orchiopexy may reduce the risk of testicular cancer if it's done when a child is younger, but it's not as clear if it's helpful if the child is older. The best time to do this surgery is not clear. Experts in the United States recommend that orchiopexy be done soon after the child’s first birthday for reasons that aren't related to cancer (such as fertility).

Family history

Having a father or brother with testicular cancer increases the risk that you will get it too. But only a small number of testicular cancers occur in families. Most men with testicular cancer do not have a family history of the disease.

Klinefelter syndrome is an inherited disease that's also linked to an increased risk of testicular cancer.

HIV infection

Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.

Carcinoma in situ

Carcinoma in situ (CIS)often doesn’t cause a lump in the testicles or any other symptoms. It isn’t clear how often CIS in the testicles progresses to cancer. In some cases, CIS is found in men who have a testicular biopsy to evaluate infertility or have a testicle removed because of cryptorchidism. Doctors in Europe are more likely than doctors in the US to look for CIS. This may be why the numbers for diagnosis and progression of CIS to cancer are lower in the US than in parts of Europe.

Since we don’t know how often CIS becomes true (invasive) cancer, it isn’t clear if treating CIS is a good idea. Some experts think that it may be better to wait and see if the disease gets worse or becomes a true cancer. This could allow many men with CIS to avoid the risks and side effects of treatment. When CIS is treated, radiation or surgery to remove the testicle is used.

Cancer in the other testicle

A personal history of testicular cancer is another risk factor. About 3-4% of men who have been cured of cancer in one testicle will, at some point, develop cancer in the other testicle.

Age

About half of testicular cancers occur in men between the ages of 20 and 45. But this cancer can affect males of any age, including infants and elderly men.

Race and ethnicity

White, American Indian, and Alaska Native men are several times more likely to get testicular cancer than Black, Asian American, and Pacific Islander men. The reason for this is not known.

Worldwide, the risk of developing this disease is highest among men living in the US and Europe and lowest among men living in Africa or Asia.

Body size

Several studies have found that tall men have a somewhat higher risk of testicular cancer, but some other studies have not. Most studies have not found a link between testicular cancer and body weight.

Unproven or controversial risk factors

Prior injury or trauma to the testicles and recurrent actions, such as horseback riding, do not appear to be related to the development of testicular cancer.

Most studies have not found that strenuous physical activity increases testicular cancer risk. Being physically active has been linked with a lower risk of several other forms of cancer, as well as a lower risk of many other health problems.