{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:36:40Z","timestamp":1777948600443,"version":"3.51.4"},"reference-count":50,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":118,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2024-03748"],"award-info":[{"award-number":["2024-03748"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007687","name":"Swedish Society of Medicine","doi-asserted-by":"crossref","award":["SLS-984649"],"award-info":[{"award-number":["SLS-984649"]}],"id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Swedish governmental","award":["ALF-2023-YF0030"],"award-info":[{"award-number":["ALF-2023-YF0030"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjonc"],"accepted":{"date-parts":[[2026,4,17]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the extent to which epididymo-orchitis or urinary tract infections (UTI) may precede testicular cancer (TC) in Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We conducted a nationwide, open-cohort study including 8 382 433 men between 1964 and 2018. Standardised incidence ratios (SIR) with 95% CIs were calculated to compare TC incidence rates in men diagnosed with epididymo-orchitis or UTI\u2014either in the same calendar year as TC or in preceding calendar years (mean follow-up: 6.85 years, \u00b18.31\u2009SD)\u2014with those in men without these infections. Analyses were controlled for potential confounders and a sensitivity analysis on cystitis was also conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 11\u2009903 men were diagnosed with TC during the study period; of these, 400 (3.36%) had been diagnosed with epididymo-orchitis and 122 (1.02%) with UTI. The TC incidence rate per 100\u2009000 person-years was 5.09 (95% CI 4.99 to 5.18) for the entire study period and increased from 2.84 (2.68 to 3.02) in 1964\u20131973\u2009to 8.37 (7.99 to 8.77) in 2014\u20132018. Among men with epididymo-orchitis (n=89\u2009596), TC was diagnosed in 0.45%, with an overall SIR of 6.34 (95% CI 5.73 to 7.00) in the full model. For TC diagnosed in the same calendar year as epididymo-orchitis (289 cases), the SIR was 85.97 (76.33 to 96.50). For TC diagnosed in subsequent calendar years (111 cases) the SIR was 1.86 (1.53 to 2.24), with most cases diagnosed within 1\u20134\u2009calendar years of follow-up (65 cases). Among men with UTI (n=294\u2009201), TC was diagnosed in only 0.04%, with an overall SIR of 1.74 (1.44 to 2.08). The associations were not significant for TC diagnosed 1\u20134 years after UTI, nor between cystitis and subsequent TC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The association between epididymo-orchitis and TC was strong and persisted for several years after the infection. The findings support clinicians maintaining a heightened awareness of TC in patients with epididymo-orchitis, particularly when in diagnostic doubt or if symptoms persist, and could be a foundation for more detailed clinical studies on epididymo-orchitis as a potential TC risk factor. Although a potential link between UTI and TC was identified, the absolute risk was almost negligible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjonc-2026-001078","type":"journal-article","created":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T10:18:07Z","timestamp":1777803487000},"page":"e001078","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Testicular cancer incidence and associations with prior epididymo-orchitis or urinary tract infections: a national cohort study in Sweden, 1964\u20132018"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0670-9996","authenticated-orcid":false,"given":"Filip","family":"Jans\u00e5ker","sequence":"first","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences Malm\u00f6, Lund University, Malm\u00f6, Sweden"},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital, Region Sk\u00e5ne, Malm\u00f6, Sweden"},{"name":"Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinjun","family":"Li","sequence":"additional","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences Malm\u00f6, Lund University, Malm\u00f6, Sweden"},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital, Region Sk\u00e5ne, Malm\u00f6, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Sundquist","sequence":"additional","affiliation":[{"name":"Center for Primary Health Care Research, Department of Clinical Sciences Malm\u00f6, Lund University, Malm\u00f6, Sweden"},{"name":"University Clinic Primary Care, Sk\u00e5ne University Hospital, Region Sk\u00e5ne, Malm\u00f6, Sweden"},{"name":"Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan"},{"name":"Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909151016000_5.1.e001078.1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32810"},{"key":"2026042909151016000_5.1.e001078.2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000053866.68623.da"},{"key":"2026042909151016000_5.1.e001078.3","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.euo.2022.06.009","article-title":"Worldwide Distribution, Risk Factors, and Temporal Trends of Testicular Cancer Incidence and Mortality: A Global Analysis","volume":"5","author":"Huang","year":"2022","journal-title":"Eur Urol 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