Lance Armstrong was on top of the world. A renowned athlete and champion cyclist, he had his eye on winning the Tour de France, a strenuous bicycle race that is the dream of every professional cyclist. But then he was diagnosed with testicular cancer and his world was seemingly shattered. However, he successfully fought the disease, won the Tour de France in 1999 and brought a relatively unknown disease into the public eye. Armstrong, who appeared to be the epitome of good health and fitness, did not fit the stereotype of a typical cancer patient, but yet not only did he have a tumor in his testicles, but it had aggressively metastasized to his lungs and brain.
While relatively rare in the United States, affecting only one percent of all men, this form of cancer is the most common found in white males between the ages of 20 to 39. And according to a new study, infertility prior to developing cancer may have been a marker.
"It has already been established that testicular cancer is associated with undescended testicles, and that was our primary reason to believe that it was initiated in-utero," says the lead author of the study Julie Baker. "So if the problem actually began before they were born, then it would make sense that these men probably have abnormal reproductive profiles." Baker is a doctoral student at the State University of New York, Buffalo, in the Department of Social and Preventive Medicine. The researchers studied the men's fertility patterns - how many children they had, whether they ever fathered a child and whether they were ever diagnosed with infertility or low sperm count.
Compared with a control group, Baker found that men with testicular cancer were less likely to have fathered a child and had significantly fewer offspring than the healthy men. When narrowed to include only men who had intentionally tried to father a child, the results were similar.
"We did find that men with testicular cancer were two thirds as likely to have ever had a child," she says.
The most common problem associated with testicular cancer is a condition known as cryptorchidism - this is when the testicles of an infant haven't descended into the scrotal sac at birth. But even though this is a problem that may predispose a male to this disease, only 10 percent of men with testicular cancer had this condition at birth.
Baker says that based on their study results, it would appear that many of these men had been ill all along. "We thought that they were healthy until they developed cancer," she says, "but now it seems that this may have been a problem all along".
Some experts think that more data is needed. "The results are interesting, but I don't think we can jump too quickly to the conclusion that all men with testicular cancer are sick to begin with as the authors imply," points out Jeffrey Jones, MD, a urologic cancer specialist who also works in aerospace medicine with NASA. "There probably are a percentage of these tumors which are genetically predisposed, and there is certainly an increased risk of testicular cancer in men with undescended testes, especially when it's bilateral".
However, Jones states that previous research contradicts some of the data presented in the current study; for example, fertility numbers before and after diagnosis and cancer treatment.
Determining fertility can be difficult, Baker says, because a man would be unaware that he was having fertility problems unless he was actively trying to father a child. "Fertility is measured on a continuum, and unless they've ever tried, they wouldn't know they were infertile. It's only later then, if they want to get married and have children, they find they have a problem."
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