No evidence for seasonal variations of the incidence of testicular germ cell tumours in Germany

Abstract

The pathogenesis of testicular germ cell tumours (GCTs) is still incompletely understood. Any progress in its understanding must derive from observational studies. Recently, it has been suggested that the incidence of GCTs may follow a seasonal pattern based on circannual changes in the Vitamin D serum levels, with maximum incidence rates in winter months. To examine this promising hypothesis, we studied monthly incidence rates of testicular GCTs in Germany by analysing 30,988 GCT cases aged 15–69 years, diagnosed during 2009–2019. Monthly incident case numbers with data regarding histology and patient age were obtained from the Robert Koch Institut, Berlin, along with annual male population counts. We used precision weighting for deriving pooled monthly incidence rates for GCTs of the period 2009–2019. We stratified pooled rates by histology (seminoma and nonseminoma) and age (15–39 and 40–69 years). By assuming a cyclical effect, we used an estimator of the intensity of seasonal occurrence and report seasonal relative risks (RR). The mean monthly incidence rate was 11.93/105 person-months. The seasonal RR for testicular cancer over-all is 1.022 (95% CI 1.000–1.054). The highest seasonal RR was found in the subgroup of nonseminoma aged 15–39 years, with a RR 1.044 (95% CI 1.000–1.112). The comparison of the pooled monthly rates of the winter months (October—March) with the summer months (April-September) revealed a maximum relative difference of 5% (95% CI 1–10%) for nonseminoma, aged 15–39 years. We conclude that there is no evidence of a seasonal variation of incidence rates of testicular cancer. Our results are at odds with an Austrian study, but the present data appear sound because the results were obtained with precision weighted monthly incidence rates in a large population of GCT cases.