Increased cancer risk and azoospermia
TO THE EDITOR:
We thank the distinguished author for
bringing attention to our work.
As Dr. Schlegel points out, a natural conclusion to draw
from the manuscript is that a male factor evaluation is of crit-
ical importance for a man's reproductive and overall health
(1)
. Indeed, it is estimated that 20% of infertile couples do
not receive a male evaluation in the United States
(2)
.Asis
noted, the current estimates may be an underestimate of a
man's lifetime risk. The current analysis followed men for a
relatively short period of time (up to 15 years) compared
with a man's complete lifespan (76.3 years)
(3, 4)
. Thus, it is
possible that his lifetime risk of cancer would continue to
rise as he ages.
Dr. Schlegel does point out some limitations related to the
granularity of information on each man. As is noted, infertile
men are generally of higher socioeconomic status compared
with the general population
(5)
. However, access to care
should be independent of semen parameters. Thus it is un-
likely that the elevated cancer risk seen in azoospermic men
could be entirely explained by socioeconomic factors. We
look forward to seeing other groups substantiate our
fi
ndings.
Michael L. Eisenberg, M.D.
a
Paul Betts, M.S.
b
Danielle Herder, M.D.
c
Dolores J. Lamb, Ph.D.
c
Larry I. Lipshultz, M.D.
c
a
Stanford University School of Medicine, Stanford,
California;
b
Cancer Epidemiology and Surveillance
Branch, Texas Cancer Registry, Texas Department of State
Health Services, Austin, Texas; and
c
Baylor College of
Medicine, Houston, Texas
June 13, 2013
REFERENCES
1.
Schlegel PN. The relevance of increased cancer risk in infertile men. Fertil Steril
2013
.
2.
Eisenberg ML, Lathi RB, Baker VL, Westphal LM, Milki AA, Nangia AK. Fre-
quency of the male infertility evaluation: data from the national survey of fam-
ily growth. J Urol 2013;189:1030
–
4
.
3.
Murphy SL, Xu J, Kochanek KD. Deaths:
fi
nal data for 2010. Natl Vital Stat Rep
2013;61:1
–
167
.
4.
Eisenberg ML, Betts P, Herder D, Lamb DJ, Lipshultz LI. Increased risk of cancer
among azoospermic men. Fertil Steril 2013
.
5.
Hotaling JM, Davenport MT, Eisenberg ML, VanDenEeden SK, Walsh TJ. Men
who seek infertility care may not represent the general U.S. population: data
from the National Survey of Family Growth. Urology 2012;79:123
–
7
.
e12
VOL. 100 NO. 3 / SEPTEMBER 2013
LETTER TO THE EDITOR