{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:18:16Z","timestamp":1792660696328,"version":"4.5.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U01 CA164947"],"award-info":[{"award-number":["U01 CA164947"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U01 CA164947"],"award-info":[{"award-number":["U01 CA164947"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA114478"],"award-info":[{"award-number":["R01 CA114478"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01 CA114478"],"award-info":[{"award-number":["R01 CA114478"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CCSG P30 CA016672"],"award-info":[{"award-number":["CCSG P30 CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1\u20132, or \u22653 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR<jats:sub>\u22653 exposures<\/jats:sub>, 1.78; 95% CI, 1.15\u20132.76; p = 0.010), lower GI series or barium enema (OR<jats:sub>\u22653 exposures<\/jats:sub>, 4.58; 95% CI, 2.39\u20138.76; p&lt;0.001), and the combined exposure variable (OR<jats:sub>\u22653 exposures<\/jats:sub>, 1.59; 95% CI, 1.05\u20132.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0\u201310 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91\u20134.42; p = 0.086).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Exposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0239321","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T18:23:19Z","timestamp":1605118999000},"page":"e0239321","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Lower abdominal and pelvic radiation and testicular germ cell tumor risk"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9680-8298","authenticated-orcid":true,"given":"Kevin T.","family":"Nead","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandita","family":"Mitra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benita","family":"Weathers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8933-9320","authenticated-orcid":true,"given":"Louisa","family":"Pyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nnadozie","family":"Emechebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna A.","family":"Pucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda A.","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Vaughn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Nathanson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Kanetsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"issue":"6","key":"pone.0239321.ref001","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.eururo.2013.11.004","article-title":"International variations and trends in testicular cancer incidence and mortality","volume":"65","author":"A Znaor","year":"2014","journal-title":"Eur Urol"},{"issue":"4","key":"pone.0239321.ref002","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/j.1365-2605.2007.00760.x","article-title":"Genetic and environmental risk factors for testicular cancer","volume":"30","author":"L Richiardi","year":"2007","journal-title":"Int J Androl"},{"issue":"22","key":"pone.0239321.ref003","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1056\/NEJMra072149","article-title":"Computed tomography\u2014an increasing source of radiation exposure","volume":"357","author":"DJ Brenner","year":"2007","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0239321.ref004","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1038\/s41467-019-09302-x","article-title":"Genome-scale Capture C promoter interactions implicate effector genes at GWAS loci for bone mineral density","volume":"10","author":"A Chesi","year":"2019","journal-title":"Nat Commun"},{"issue":"965","key":"pone.0239321.ref005","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1259\/bjr\/01948454","article-title":"Cancer risks from diagnostic radiology","volume":"81","author":"EJ Hall","year":"2008","journal-title":"Br J Radiol"},{"issue":"24","key":"pone.0239321.ref006","doi-asserted-by":"crossref","first-page":"13761","DOI":"10.1073\/pnas.2235592100","article-title":"Cancer risks attributable to low doses of ionizing radiation: assessing what we really know","volume":"100","author":"DJ Brenner","year":"2003","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"9","key":"pone.0239321.ref007","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1056\/NEJMoa0901249","article-title":"Exposure to low-dose ionizing radiation from medical imaging procedures","volume":"361","author":"R Fazel","year":"2009","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0239321.ref008","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1148\/radiol.2481071451","article-title":"Effective doses in radiology and diagnostic nuclear medicine: a catalog","volume":"248","author":"FA Mettler","year":"2008","journal-title":"Radiology"},{"issue":"8","key":"pone.0239321.ref009","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jamapediatrics.2013.311","article-title":"The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk","volume":"167","author":"DL Miglioretti","year":"2013","journal-title":"JAMA Pediatr"},{"issue":"2","key":"pone.0239321.ref010","doi-asserted-by":"crossref","first-page":"273","DOI":"10.2214\/AJR.07.3526","article-title":"The Image Gently campaign: working together to change practice","volume":"190","author":"MJ Goske","year":"2008","journal-title":"AJR Am J Roentgenol"},{"issue":"17","key":"pone.0239321.ref011","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1093\/jnci\/81.17.1307","article-title":"Breast cancer in women with scoliosis exposed to multiple diagnostic x rays","volume":"81","author":"DA Hoffman","year":"1989","journal-title":"J Natl Cancer Inst"},{"issue":"16","key":"pone.0239321.ref012","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1097\/00007632-200008150-00009","article-title":"Breast cancer mortality after diagnostic radiography: findings from the U.S. Scoliosis Cohort Study","volume":"25","author":"MM Doody","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"pone.0239321.ref013","doi-asserted-by":"crossref","first-page":"447","DOI":"10.3109\/02841861003705778","article-title":"Dental x-rays and the risk of thyroid cancer: a case-control study","volume":"49","author":"A Memon","year":"2010","journal-title":"Acta Oncol"},{"issue":"9840","key":"pone.0239321.ref014","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S0140-6736(12)60815-0","article-title":"Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study","volume":"380","author":"MS Pearce","year":"2012","journal-title":"Lancet"},{"issue":"5","key":"pone.0239321.ref015","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1007\/s00330-008-1241-1","article-title":"Dose reduction in computed tomography: the effect of eye and testicle shielding on radiation dose measured in patients with beryllium oxide-based optically stimulated luminescence dosimetry","volume":"19","author":"H Grobe","year":"2009","journal-title":"Eur Radiol"},{"issue":"977","key":"pone.0239321.ref016","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1259\/bjr\/86609718","article-title":"The use of gonad shielding in paediatric hip and pelvis radiographs","volume":"82","author":"SL Fawcett","year":"2009","journal-title":"Br J Radiol"},{"key":"pone.0239321.ref017","volume-title":"SEER Cancer Statistics Review, 1975\u20132016","author":"N Howlader","year":"2016"},{"issue":"11","key":"pone.0239321.ref018","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1093\/aje\/kwt164","article-title":"Comparison of address-based sampling and random-digit dialing methods for recruiting young men as controls in a case-control study of testicular cancer susceptibility","volume":"178","author":"B Clagett","year":"2013","journal-title":"Am J Epidemiol"},{"issue":"10","key":"pone.0239321.ref019","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.jclinepi.2006.01.014","article-title":"Review: a gentle introduction to imputation of missing values","volume":"59","author":"AR Donders","year":"2006","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"pone.0239321.ref020","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1002\/cncr.21670","article-title":"In utero exposure to female hormones and germ cell tumors in children","volume":"106","author":"S Shankar","year":"2006","journal-title":"Cancer"},{"issue":"6","key":"pone.0239321.ref021","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1038\/ng.2634","article-title":"Meta-analysis identifies four new loci associated with testicular germ cell tumor","volume":"45","author":"CC Chung","year":"2013","journal-title":"Nat Genet"},{"issue":"5","key":"pone.0239321.ref022","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1038\/ng.569","article-title":"Germline mutations in breast and ovarian cancer pedigrees establish RAD51C as a human cancer susceptibility gene","volume":"42","author":"A Meindl","year":"2010","journal-title":"Nat Genet"},{"issue":"3","key":"pone.0239321.ref023","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1088\/0952-4746\/30\/3\/R01","article-title":"Testicular cancer risk associated with occupational radiation exposure: a systematic literature review","volume":"30","author":"L Yousif","year":"2010","journal-title":"J Radiol Prot"},{"issue":"4","key":"pone.0239321.ref024","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/jech.41.4.349","article-title":"Testicular cancer in young men: the search for causes of the epidemic increase in the United States","volume":"41","author":"LM Brown","year":"1987","journal-title":"J Epidemiol Community Health"},{"issue":"2","key":"pone.0239321.ref025","doi-asserted-by":"crossref","first-page":"75","DOI":"10.2203\/dose-response.04-002.Mitchel","article-title":"Low doses of radiation are protective in vitro and in vivo: evolutionary origins","volume":"4","author":"RE Mitchel","year":"2006","journal-title":"Dose Response"},{"issue":"2","key":"pone.0239321.ref026","doi-asserted-by":"crossref","first-page":"172","DOI":"10.2203\/dose-response.09-037.Vaiserman","article-title":"Radiation hormesis: historical perspective and implications for low-dose cancer risk assessment","volume":"8","author":"AM Vaiserman","year":"2010","journal-title":"Dose Response"},{"key":"pone.0239321.ref027","volume-title":"SEER Cancer Statistics Review, 1975\u20132015","author":"AM Noone","year":"2018"},{"issue":"2 Suppl","key":"pone.0239321.ref028","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.2307\/3578892","article-title":"Cancer incidence in atomic bomb survivors. Part II: Solid tumors, 1958\u20131987","volume":"137","author":"DE Thompson","year":"1994","journal-title":"Radiat Res"},{"issue":"1","key":"pone.0239321.ref029","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/0895-4356(90)90060-3","article-title":"Recall bias in epidemiologic studies","volume":"43","author":"SS Coughlin","year":"1990","journal-title":"J Clin Epidemiol"},{"issue":"6","key":"pone.0239321.ref030","doi-asserted-by":"crossref","first-page":"772","DOI":"10.6004\/jnccn.2015.0092","article-title":"Testicular Cancer, Version 2.2015","volume":"13","author":"RJ Motzer","year":"2015","journal-title":"J Natl Compr Canc Netw"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0239321","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T18:23:44Z","timestamp":1605119024000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0239321"}},"subtitle":[],"editor":[{"given":"Sabine","family":"Rohrmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0239321","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,11]]}}}