Environmental Factors Affecting Growth and Occurrence of Testicular Cancer in Childhood: An Overview of the Current Epidemiological Evidence.

Testicular cancer (TC) is the most frequently occurring malignancy among adolescents and young men aged 15-34 years. Although incidence of TC has been growing over the past 40 years in several western countries, the explanations for this increase still remain uncertain. It has been postulated that early life exposure to numerous occupational and environmental estrogenic chemicals, such as endocrine-disrupting chemicals (EDCs), may play a contributing role in the etiology of TC, but the subject is still open to additional investigation. Recently, it has also been suggested that prenatal and postnatal environmental exposures associated with child growth and development might also be involved in TC progression. This review of current epidemiological studies (2000-2015) aims to identify environmental factors associated with TC, with a particular focus on infancy and childhood factors that could constitute a risk for disease development. It may also contribute towards recognizing gaps in knowledge and recent research requirements for TC, and to point out possible interactions between child growth and development in relation to prenatal and postnatal environmental exposures.

Effect of endogenous and exogenous hormones on testicular cancer: the epidemiological evidence.

Testicular cancer is the most common type of malignancy in men aged 15-40 years. Although its incidence has increased over the past 40 years in most countries, the reasons for this rise are unclear. It has been suggested that a relative excess of endogenous estrogens during prenatal life and/or later exposures to various occupational and environmental estrogenic chemicals such as organochlorine compounds may play a causal role in the etiology of testicular cancer, but the issue is still open to further research. The purpose for this review is to summarize the epidemiologic literature about hormonal factors, endogenous hormones and environmental xenoestrogens, and testicular carcinogenesis. Future studies need to (a) consider the possible synergistic effect of exposure to environmental xenoestrogens and sex hormones, (b) focus on the most vulnerable life stages of exposure to endocrine disruptors and testicular cancer risk, (c) assess the possible additive role of androgen secretion occurring during puberty in tumor progression, and (d) consider more systematically gene-environment interactions.

Case-control study of anthropometric measures and testicular cancer risk.

The etiology of testicular germ cell tumors (TGCTs) is poorly understood. Recent epidemiological findings suggest that, TGCT risk is determined very early in life, although the available data are still conflicting. The rapid growth of the testes during puberty may be another period of vulnerability. Body size has received increasing attention as possible risk factor for TC. To clarify the relation of body size and its anthropometric variables to TGCT risk, the authors analyzed data from 272 cases and 382 controls with regard to height (cm), weight (Kg), and body mass index (BMI; kg/m(2)). Overall, participants in the highest quartile of height were more likely to be diagnosed with TGCTs than participants in the lowest quartile of height, OR 2.22 (95% confidence intervals (CI): 1.25-3.93; adjusted; p(trend) = 0.033). Moreover, histological seminoma subgroup was significantly associated with tallness, very tall men (>182 cm) having a seminoma TGCT risk of OR = 2.44 (95% confidence intervals (CI): 1.19-4.97; adjusted; p(trend) = 0.011). There was also a significant inverse association of TGCT with increasing BMI (p(trend) = 0.001; age-adjusted analysis) and this association was equally present in both histological subgroups. These preliminary results indicate that testicular cancer (TC) is inversely associated with BMI and positively associated with height, in particular with seminoma subtype. Several studies have reported similar findings on body size. As adult height is largely determined by high-calorie intake in childhood and influenced by hormonal factors at puberty, increased attention to postnatal exposures in this interval may help elucidate the etiology of TGCTs.

Pesticide exposure and serum organochlorine residuals among testicular cancer patients and healthy controls.

The incidence of testicular cancer (TC) has been increasing worldwide during the last decades. The reasons of the increase remains unknown, but recent findings suggest that organochlorine pesticides (OPs) could influence the development of TC. A hospital-based case-control study of 50 cases and 48 controls was conducted to determine whether environmental exposure to OPs is associated with the risk of TC, and by measuring serum concentrations of OPs, including p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) isomer and hexachlorobenzene (HCB) in participants. A significant association was observed between TC and household insecticide use (odds ratio [OR] = 3.01, 95 % CI: 1.11-8.14; OR(adjusted) = 3.23, 95 % CI: 1.15-9.11). Crude and adjusted ORs for TC were also significantly associated with higher serum concentrations of total OPs (OR = 3.15, 95 % CI: 1.00-9.91; OR(adjusted) = 3.34, 95 % CI: 1.09-10.17) in cases compared with controls. These findings give additional support to the results of previous research that suggest that some environmental exposures to OPs may be implicated in the pathogenesis of TC.

Correlation analysis of cocoa consumption data with worldwide incidence rates of testicular cancer and hypospadias.

The underlying reasons for the increasing occurrence of male reproductive diseases (MRD) such as hypospadias, cryptorchidism, and testicular cancer (TC) over the last decades are still unknown. It has been hypothesized that the risk of MRD is determined in utero and that pregnancy dietary intake could also affect MRD risk in the offspring. Various studies in animals reported that cocoa and theobromine, the main stimulant of cocoa, exert toxic effects on the testis, inducing testicular atrophy and impaired sperm quality. A correlation analysis was conducted to examine the possible role of cocoa consumption on the occurrence of selected MRD during the prenatal and early life period of cases. The incidence rates between 1998-2002 of TC in 18 countries obtained from Cancer Incidence in Five Continents were correlated with the average per-capita consumption of cocoa (kg/capita/year) (FAOSTAT-Database) in these countries from 1965 to 1980, i.e. the period corresponding to the early life of TC cases. In order to test the above correlation in the case of hypospadias, the mean prevalence at birth in 20 countries (1999-2003) with average per-capita consumption of cocoa in these countries in the same period corresponding to pregnancy were used. The consumption of cocoa in the period 1965-80, was most closely correlated with the incidence of TC in young adults (r=0.859; p<0.001). An analogous significant correlation was also observed between early cocoa consumption and the prevalence rates of hypospadias in the period 1999-2003 (r=0.760; p<0.001). Although the ecological approach used in this study cannot provide an answer on the causal relationship between consumption of cocoa in early life and TC and hypospadias, the results are suggestive and indicate the need of further analytic studies to investigate the role of individual exposure to cocoa, particularly during the prenatal and in early life of the patients.

The use of personal protective equipment in pregnant greenhouse workers.

AIM: To determine the use of personal protective equipment (PPE) among pregnant greenhouse workers in Italy and to identify risk factors related to the non-use of appropriate preventive measures. METHODS: A structured questionnaire was administered by trained interviewers, to Italian female greenhouse workers regarding their use of PPE and the occurrence of adverse pregnancy outcomes in their first pregnancy. RESULTS: Two hundred and thirty-two workers participated. Although most pregnant women used at least one form of PPE while working, there were differences in PPE use in different social groups. Overall, the protection was inadequate in the south of Italy and among the less educated. Pregnant women performing the most dangerous jobs often did so without using PPE. Even the use of gloves was absent in 50% of pregnant women who during their pregnancy prepared and mixed pesticides, and among 38% of those who applied pesticides directly. CONCLUSIONS: The use of protective measures was inadequate in the south of Italy and among less educated women. The study indicates the need for urgent interventions aimed at improving PPE use during pregnancy.