Testicular cancer survival rates improved dramatically after cisplatin-based therapy was introduced in the 1970s. However,
chemotherapy and radiation therapy are potentially carcinogenic. The purpose of this study was to estimate the risk of developing
second primary cancers including the risk associated with primary histologic type (seminoma and non-seminoma) among testicular
cancer survivors in Germany. We identifi ed 16 990 and 1401 cases of testicular cancer in population-based cancer registries of East
Germany (1961–1989 and 1996–2008) and Saarland (a federal state in West Germany; 1970–2008), respectively. We estimated the
risk of a second primary cancer using standardized incidence ratios (SIRs) with 95% confi dence intervals (95% CIs). To determine
trends, we plotted model-based estimated annual SIRs. In East Germany, a total of 301 second primary cancers of any location were
observed between 1961 and 1989 (SIR: 1.9; 95% CI: 1.7–2.1), and 159 cancers (any location) were observed between 1996 and
2008 (SIR: 1.7; 95% CI: 1.4–2.0). The SIRs for contralateral testicular cancer were increased in the registries with a range from
6.0 in Saarland to 13.9 in East Germany. The SIR for seminoma, in particular, was higher in East Germany compared to the other
registries. We observed constant trends in the model-based SIRs for contralateral testicular cancers. The majority of reported SIRs
of other cancer sites including histology-specifi c risks showed low precisions of estimated effects, likely due to small sample sizes.
Testicular cancer patients are at increased risk especially for cancers of the contralateral testis and should receive intensive follow-ups.

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