Abstract
Purpose:
Aberrations in reproductive fitness may be a harbinger of medical diseases in men. Data suggest a higher risk of testicular cancer in infertile men. However, the relationship between infertility and other cancers remains uncertain.
Materials and Methods:
We analyzed subjects from the Truven Health MarketScan® claims database from 2001 to 2009. Infertile men were identified through diagnosis and treatment codes. Comparison groups were created of men who underwent vasectomy and a control cohort of men who were not infertile and had not undergone vasectomy. The incidence of cancer was compared to national U.S. estimates. Infertile men were also compared to men who underwent vasectomy and the control cohort using a Cox regression model.
Results:
A total of 76,083 infertile men were identified with an average age of 35.1 years. Overall 112,655 men who underwent vasectomy and 760,830 control men were assembled. Compared to age adjusted national averages, infertile, vasectomy and control subjects in the study cohorts had higher rates of all cancers and many individual cancers. In time to event analysis, infertile men had a higher risk of cancer than those who underwent vasectomy or controls. Infertile men had a higher risk of testis cancer, nonHodgkin lymphoma and all cancers than the vasectomy and control groups.
Conclusions:
Consistent with prior reports, we identified an increased risk of testicular cancer in infertile men. The current data also suggest that infertile men are at an increased risk of all cancers in the years after infertility evaluation. Future research should focus on confirming these associations and elucidating pathways between infertility and cancer.
References
- 1 : Risk of testicular cancer in subfertile men: case-control study. BMJ1999; 318: 559. Google Scholar
- 2 : Risk of testicular cancer in men with abnormal semen characteristics: cohort study. BMJ2000; 321: 789. Google Scholar
- 3 : Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med2009; 169: 351. Google Scholar
- 4 : Increased risk of high-grade prostate cancer among infertile men. Cancer2010; 116: 2140. Google Scholar
- 5 : Male infertility and prostate cancer risk: a nested case-control study. Cancer Causes Control2010; 21: 1635. Google Scholar
- 6 : Breast cancer in men: risk factors with hormonal implications. Am J Epidemiol1992; 135: 734. Google Scholar
- 7 : Increased cancer risk and azoospermia. Fertil Steril2013; 100: 681. Google Scholar
- 8 : Male infertility: a risk factor for testicular cancer. Nat Rev Urol2009; 6: 550. Google Scholar
- 9 : Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects. Hum Reprod2001; 16: 972. Google Scholar
- 10 : The biology of infertility: research advances and clinical challenges. Nat Med2008; 14: 1197. Google Scholar
- 11 : Clinical genetic testing for male factor infertility: current applications and future directions. Andrology2014; 2: 339. Google Scholar
- 12 : Racial differences in vasectomy utilization in the United States: data from the national survey of family growth. Urology2009; 74: 1020. Google Scholar
- 13 National Cancer Institute: Surveillance Research Program: The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute 2014. Google Scholar
- 14 : Subfertility and the risk of testicular germ cell tumors (United States). Cancer Causes Control2005; 16: 651. Google Scholar
- 15 : Fatherhood and incident prostate cancer in a prospective US cohort. Int J Epidemiol2011; 40: 480. Google Scholar
- 16 : Reduced risk of prostate cancer in men who are childless as compared to those who have fathered a child: a population based case-control study. Int J Cancer2005; 115: 994. Google Scholar
- 17 : Fatherhood status and prostate cancer risk. Cancer2008; 112: 919. Google Scholar
- 18 : Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Medical Care2002; 40: IV. Google Scholar
- 19 : Mortality results from a randomized prostate-cancer screening trial. N Engl J Med2009; 360: 1310. Google Scholar
- 20 : Screening and prostate-cancer mortality in a randomized European study. N Engl J Med2009; 360: 1320. Google Scholar
- 21 : Health disparities in clinical practice patterns for prostate cancer screening by geographic regions in the United States: a multilevel modeling analysis. Prostate Cancer Prostatic Dis2013; 16: 193. Google Scholar
- 22 : Body size and renal cell cancer incidence in a large US cohort study. Am J Epidemiol2008; 168: 268. Google Scholar
- 23 : Body mass index, physical activity, and bladder cancer in a large prospective study. Cancer Epidemiol Biomarkers Prev2008; 17: 1214. Google Scholar
- 24 : Cigarette smoking and subsequent risk of lung cancer in men and women: analysis of a prospective cohort study. Lancet Oncol2008; 9: 649. Google Scholar
- 25 : Vasectomy and prostate cancer. Chance, bias, or a causal relationship?. JAMA1993; 269: 913. Google Scholar
- 26 : Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. J Clin Oncol2014; 32: 3033. Google Scholar
- 27 : Fetal origins of coronary heart disease. BMJ1995; 311: 171. Google Scholar
- 28 : BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis. Hum Reprod Update2013; 19: 221. Google Scholar
- 29 : Men who seek infertility care may not represent the general U.S. population: data from the National Survey of Family Growth. Urology2012; 79: 123. Google Scholar
- 30 : Observational intensity bias associated with illness adjustment: cross sectional analysis of insurance claims. BMJ2013; 346: f549. Google Scholar
