Disparities in Stage at Diagnosis among Adult Testicular Germ Cell Tumor Patients in the National Cancer Data Base, 1999-2008

Introduction: Testicular germ cell tumors (TGCTs) are the most common malignancy among U.S. men ages 15-34, and incidence is increasing. Patients diagnosed with late-stage TGCTs have poorer 5-year survival, but few studies have examined the sociodemographic predictors of late-stage diagnosis.

Methods: 43,043 men ages 18-64 diagnosed with invasive TGCTs diagnosed during 1999-2008 were selected from the National Cancer Data Base, a U.S. hospital-based cancer registry. The impact of health insurance status and race/ethnicity on late-stage diagnosis (stage III) was explored for all TGCTs, adjusting for tumor histology, ZIP code-level education, age, diagnosis year, and geographic region. Multivariate log binomial models were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs).

Results: 5,812 (13.5%) men were diagnosed with late-stage disease. Being uninsured (RR, 1.58; 95% CI, 1.48-1.69), Medicaid-insured (RR, 2.14; 95% CI, 2.00-2.28), or Medicare-insured (RR, 1.83; 95% CI, 1.64-2.05) was associated with late-stage diagnosis compared to the privately insured; African Americans (RR, 1.28; 95% CI, 1.14-1.43) and Hispanics (RR, 1.23; 95% CI, 1.15-1.32) were also at increased risk compared to non-Hispanic whites. Nonseminomatous histology was also associated with late-stage diagnosis (RR, 2.62; 95% CI: 2.49-2.76).

Conclusions: Although the large majority of men in our study were diagnosed with early-stage disease, sociodemographic variables, particularly insurance status, were predictors of late-stage diagnosis among TGCT patients. Strong associations between insurance and disease severity may be related to lack of access to preventive services and barriers to medical evaluation. Future efforts should aim to increase access to preventive care and disseminate information regarding the symptoms of TGCTs in underserved populations.