Increased risk of cancer among azoospermic men

Capsule:
Men with azoospermia have an increased risk of subsequently developing cancer, suggesting a possible common etiology between azoospermia and cancer development.

Authors:
Michael L. Eisenberg, M.D., Paul Betts, M.S., Danielle Herder, M.D., Dolores J. Lamb, Ph.D., Larry I. Lipshultz, M.D.

Volume 100, Issue 3, Pages 681-685.e1, September 2013

Abstract:

Objective:
To determine whether men with azoospermia are at an elevated risk of developing cancer in the years following an infertility evaluation.

Design:
Cohort study.

Setting:
United States andrology clinic.

Patient(s):
A total of 2,238 men with complete records were evaluated for infertility at a single andrology clinic in Texas from 1989 to 2009.

Intervention(s):
None.

Main Outcome Measure(s):
Cancer incidence was determined by linkage to the Texas Cancer Registry.

Result(s):
In all, 451 men had azoospermia, and 1,787 were not azoospermic, with a mean age at infertility evaluation of 35.7 years. Compared with the general population, infertile men had a higher risk of cancer, with 29 cases observed compared with 16.7 expected (standardized incidence rate [SIR] 1.7, 95% confidence interval [CI] 1.2–2.5). When stratifying by azoospermia status, azoospermic men had an elevated risk of cancer (SIR 2.9, 95% CI 1.4–5.4). Infertile men without azoospermia had a trend toward a higher rate of cancer (SIR 1.4, 95% CI 0.9–2.2). The Cox regression model revealed that azoospermic men had 2.2-fold higher cancer risk compared with nonazoospermic men (hazard ratio 2.2, 95% CI 1.0–4.8).

Conclusion(s):
Men with azoospermia have an increased risk of subsequently developing cancer, suggesting a possible common etiology between azoospermia and cancer development. Additional follow-up of azoospermic men after reproductive efforts end may be warranted.

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