Impact of diagnostic delay in testis cancer: Results of a large population-based study

Objective: Testis cancer is the most common cancer in young men, and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. Diagnostic delay (DD), defined as the time elapsing from the onset of tumour symptoms to the day of diagnosis, is a way to evaluate the rapidity of diagnosis. We assessed the relationship between DD, disease stage, and survival rate. Methods: A series of 542 patients diagnosed with a germ cell tumour between 1983 and 2002 at health facilities in the Midi-Pyrenees region, southwest France, were asked about DD. We analysed DD together with data regarding the disease (histologic type, stage), its treatments, and prognosis (impact on survival). Results: Mean DD was longer in seminoma (4.9 +/- 6.1 mo) than in non-seminomatous germ cell tumour (NSGCT; 2.8 +/- 4.0 mo). DD was correlated with disease stage for the whole population (p = 0.014) and for NSGCT (p = 0.0009), but not for seminoma. DD had a significant impact on the 5-yr survival rate in the overall population (p = 0.001) and in the NSGCT group (p = 0.001), but not in the seminoma group. Global trends in mean DD did not change over the 20-yr study period, but we observed a slight decrease during the last decade. Conclusions: DD is highly correlated with stage and survival in NSGCT. Urologists should promote programmes to enhance awareness and knowledge of testis cancer, so the diagnosis can be made more rapidly. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.