Trends in the incidence of testicular germ cell cancer in Ontario by histologic subgroup, 1964-1996

BACKGROUND: Testicular cancer is rare but is notable because it affects mainly young men. The incidence of this disease has been increasing in developed countries throughout the world for several decades. The authors examined trends in the incidence of testicular germ cell cancer in Ontario for the period 1964-1996 according to the 2 main histologic groups, seminoma and non-seminoma. METHODS: Data on incident cases of testicular germ cell cancer diagnosed in Ontario residents aged 15-59 years between 1964 and 1996 were extracted from the population-based Ontario Cancer Registry. Annual rates of testicular cancer for the 2 histologic groups were analysed by means of log-linear regression to estimate average annual percent change. RESULTS: Between 1964 and 1996 the incidence of testicular germ cell cancer increased by 59.4%, from 4.01 to 6.39 per 100,000. This corresponded to an average annual increase of about 2% for both nonseminoma and seminoma. The relative increase in incidence was greatest in the lowest age group (15-29 years) for both histologic groups, although the data suggest that the incidence of nonseminoma cancer in this age group began to decline in the early 1990s. The increase in incidence appears to be due to a birth cohort effect, with more recent cohorts of men at increased risk. INTERPRETATION: The rise in the incidence of testicular germ cell cancer, not only in Ontario but also in many developed countries, requires investigation. The search for explanatory factors should focus on exposures whose prevalence may have increased over the past few decades and that are common enough to affect population incidence. The similarity of trends for seminoma and nonseminoma cancer suggests that the underlying risk factors are likely the same.     

A disequilibrium coefficient approach to Hardy-Weinberg testing

A comparison was made of various tests for Hardy-Weinberg equilibrium, with emphasis on methods for multiple alleles. For an overall test of deviations from equilibrium, the classical chi-square goodness-of-fit test generally performs well, with continuity corrections needed for extreme gene frequencies or extreme departures from equilibrium. For small samples, probability tests are preferable and for multiple alleles these probability tests may be performed on a sample of all possible sets of genotypic frequencies having a fixed set of sample gene frequencies. Numerical work showed that the continuity-corrected chi-square was the most conservative test procedure, and the uncorrected chi-square the least conservative. With multiple alleles, a better appreciation of the nature of departures from equilibrium is given by the use of disequilibrium coefficients, defined for each heterozygote as the difference between observed and expected frequencies. Likelihood-ratio tests can be used to test each of these coefficients individually but a satisfactory procedure is to divide the squared estimate of each coefficient by its estimated variance and regard the ratio as a single-degree-of-freedom chi-square. Numerical studies confirmed the validity of this approach, which has the great advantage of not requiring solutions of nonlinear equations.