Frailty modelling of testicular cancer incidence using Scandinavian data

Biostatistics. 2004 Jan;5(1):1-14. doi: 10.1093/biostatistics/5.1.1.

Abstract

The incidence of testicular cancer is highest among young men, and then decreases sharply with age. This points towards a frailty effect, where some men have a much greater risk of testicular cancer than the majority of the male population. Those with the highest risk get cancer, drain the group of individuals at risk, and leave a healthy male population which has approximately zero risk of testicular cancer. This leads to the observed decrease in incidence. We discuss a frailty model, where the frailty is compound-Poisson-distributed. This allows for a non-susceptible group (of zero frailty). The model is successfully applied to incidence data from the Danish and Norwegian registries. It is indicated that there was a decrease in incidence for males born during World War II in both countries. Bootstrap analysis is used to find the degree of variation in the estimates. In the Armitage-Doll multistage model, the estimated number of transitions needed for a cell to become malignant is close to 3 for non-seminomas and 4 for seminomas in both the Danish and Norwegian data. This paper demonstrates that a model including a frailty effect fits the incidence data well and gives interesting results and interpretations, although this is no proof of the effect's truth.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Data Interpretation, Statistical
  • Denmark / epidemiology
  • Epidemiologic Methods*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Models, Statistical*
  • Norway / epidemiology
  • Seminoma / epidemiology*
  • Testicular Neoplasms / epidemiology*