Open Access Highly Accessed Study protocol

Studying the impact of early life exposures to pesticides on the risk of testicular germ cell tumors during adulthood (TESTIS project): study protocol

Rémi Béranger123*, Olivia Pérol1, Louis Bujan45, Elodie Faure1, Jeffrey Blain1, Charlotte Le Cornet12, Aude Flechon6, Barbara Charbotel78, Thierry Philip1, Joachim Schüz2 and Béatrice Fervers13

Author Affiliations

1 Unité Cancer et Environnement, Centre Léon Bérard, 28 rue Laennec, 69373 Lyon, 08 Cedex, France

2 Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France

3 EAM 4128 “Santé Individu Société”, Université Claude Bernard – Lyon 1, Villeurbanne, France

4 CECOS, Hôpital Paule de Viguier; Fédération Française des CECOS, CHU, Toulouse, France

5 Université de Toulouse; UPS; Groupe de recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France

6 Centre de Lutte Contre le Cancer, Centre Léon Bérard, Lyon, France

7 Université de Lyon, F-69003 Lyon, France

8 Université Lyon 1, UMRESTTE (Unité mixte IFSTTAR/UCBL), Domaine Rockefeller, 69373 Lyon, France

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BMC Cancer 2014, 14:563  doi:10.1186/1471-2407-14-563

Published: 4 August 2014



The incidence of testicular germ cell tumors (TGCT), the most common cancer in men aged 15 to 45 years, has doubled over the last 30 years in developed countries. Reasons remain unclear but a role of environmental factors, especially during critical periods of development, is strongly suspected. Reliable data on environmental exposure during this critical time period are sparse. Little is known on whether it could be a combined effect of early and later-life exposures.


Our research aims to study the association between TGCT risk and pesticide exposures (domestic, occupational and environmental) during critical time periods of development and combined early and later-life exposures. The study design, developed during a 2-year pilot study, is a multicenter case–control study of 500 cases (ascertained through histology) and 1000 fertile/fecund controls recruited through 21 French ‘Centres d’Etude et de Conservation des Œufs et de Sperme humain’ (CECOS). Trained professional interviewers interview the subjects and their mothers by phone. Using a geographic information system developed and tested for application in this study design, environmental pesticides exposure assessment is based on life-time residential history. Occupational pesticides exposures are assessed by an industrial hygienist based on parents’ occupations and tasks. Exposures during the prenatal period, early childhood and puberty are focused. A blood sample is collected from each participant to assess genetic polymorphisms known to be associated with TGCT risk, as well as to explore gene-environment interactions.


The results of our study will contribute to better understanding the causes of TGCT and the rapid increase of its incidence. We explore the effect of combined early and later-life pesticides exposure from multiple sources, as well as potential gene-environment interactions that have until now been rarely studied for TGCT. Our design allows future pooled studies and the bio-bank allows additional genetic or toxicological analyses.

Case–control studies; Pesticides; Maternal exposure; Paternal exposure; Geographic information systems; Testicular neoplasms; Germinoma; Environmental exposure; Occupational exposures; Gene-environment interaction