Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma
- 239 Downloads
The incidence of penile cancer is four times higher in Paraguay than in the United States or Europe. There are no adequate scientific explanations for this geographical variation. The goal of this study was to evaluate the interplay among risk factors, morphology of the primary tumor, and HPV status.
Information on socioeconomic status, education level, habits, and sexual history was obtained in 103 Paraguayan patients with penile cancer. All patients were then treated by surgery, and specimens were evaluated histopathologically.
Patients usually dwelled in rural/suburban areas (82%), lived in poverty (75%), had a low education level (91%), and were heavy smokers (76%). Phimosis (57%), moderate/poor hygienic habits (90%), and history of sexually transmitted diseases (74%) were frequently found. Patients with >10 lifetime female partners had an odds ratio of 3.8 (95% CI 1.1, 12.6; P-trend = .03) for presenting HPV-positive tumors when compared to patients with <6 partners. However, this trend was not significant when the number of sexual partners was adjusted for age of first coitus and antecedents of sexually transmitted diseases. HPV-related tumors (found in 36% of the samples) were characterized by a warty and/or basaloid morphology and high histological grade in most cases.
In our series, patients with penile cancer presented a distinctive epidemiologic and pathologic profile. These data might help explaining the geographical differences in incidence and aid in the design of strategies for cancer control in Paraguay.
KeywordsPenile cancer Human papillomavirus Circumcision Phimosis Lichen sclerosus Risk factors
Dr Chaux was supported by the Johns Hopkins Medicine—Patana Fund for Research.
Conflicts of interest
Authors declare no conflicts of interest.
- 1.Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, Boyle P (2007) Cancer incidence in five continents, vol IX, IARC Scientific Publications No. 160. In: IARC Press, Lyon, pp 570–573Google Scholar
- 2.Parkin DM, Muir CS, Whelan SL, Gao YT, Ferlay J, Powell J (1992) Cancer incidence in five continents, vol VI, IARC Scientific Publications No. 120. IARC Press, Lyon, France. Available at http://ci5.iarc.fr/CI5i-ix/ci5i-ix.htm
- 9.Cubilla AL, Lloveras B, Alejo M, Clavero O, Chaux A, Kasamatsu E, Velazquez EF, Lezcano C, Monfulleda N, Tous S, Alemany L, Klaustermeier J, Munoz N, Quint W, de Sanjose S, Bosch FX (2010) The basaloid cell is the best tissue marker for human papillomavirus in invasive penile squamous cell carcinoma: a study of 202 cases from Paraguay. Am J Surg Pathol 34(1):104–114PubMedCrossRefGoogle Scholar
- 11.Velazquez EF, Bock A, Soskin A, Codas R, Arbo M, Cubilla AL (2003) Preputial variability and preferential association of long phimotic foreskins with penile cancer: an anatomic comparative study of types of foreskin in a general population and cancer patients. Am J Surg Pathol 27(7):994–998PubMedCrossRefGoogle Scholar
- 12.Epstein JH, Cubilla AL, Humphrey PA (2011) Tumors of the prostate gland, seminal vesicles, penis, and scrotum. In: Atlas of Tumor Pathology. Armed Forces Institute of Pathology, Washington, DC, pp 405–612Google Scholar
- 13.Chaux A, Torres J, Pfannl R, Barreto J, Rodriguez I, Velazquez EF, Cubilla AL (2009) Histologic grade in penile squamous cell carcinoma: Visual estimation versus digital measurement of proportions of grades, adverse prognosis with any proportion of grade 3 and correlation of a Gleason-like system with nodal metastasis. Am J Surg Pathol 33(7):1042–1048PubMedCrossRefGoogle Scholar
- 14.Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK, Krieger JN (2005) Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer 116(4):606–616PubMedCrossRefGoogle Scholar
- 18.Koifman L, Vides AJ, Koifman N, Carvalho JP, Ornellas AA (2011) Epidemiological aspects of penile cancer in Rio de Janeiro: evaluation of 230 cases. Int Braz J Urol 37(2):231–240 (discussion 240–233)Google Scholar