Penile cancer leads to 400 deaths in Brazil per year, on average, according to research

Mortality from penile cancer in Brazil remained practically unchanged between 2008 and 2018, according to a survey by the ACCamargo Câncer Center hospital. The annual average is 400 deaths. The biopsies used to diagnose the disease, however, have decreased, making treatment success difficult.

The hospital researchers analyzed data from 2008 to 2018 available on Datasus, a service of the Ministry of Health that provides information about the public health system.

The leader of the hospital’s Urological Tumors Reference Center and one of the researchers, Stênio de Cássio Zequi says that penile cancer is associated with the poorest regions of the planet, such as Asia, South America and Africa — Brazil is one of the countries with higher incidence of the disease.

Zequi claims that the country has an average of 2.9 to 6.8 cases per 100,000 inhabitants. For comparison purposes, the incidence in the United States is 0.6. On the European continent, it does not exceed 1.

The explanation for the greater number of cases being concentrated in poor regions is related to an old perception in the medical literature: penile cancer is highly prevalent in underserved populations, often associated with low education levels, poor basic sanitation services and little access to an efficient health care system.

In Brazil, this becomes evident when regional differences are observed. When analyzing the HDI (Human Development Index), which takes into account income, education and health, it appears that Piauí, Tocantins and Maranhão, states with an index lower than 0.7, had the highest proportions of death from the disease.

The states with the lowest mortality rate, such as São Paulo, Santa Catarina and the Federal District, have an HDI above 0.7.

Maria Paula Curado, head of the Cancer Epidemiology and Statistics Group at AC Camargo, agrees that there is an inequality in the occurrence of the disease in Brazil, affecting mainly the North and Northeast.

Curado says that there is greater difficulty in accessing adequate health services in these two regions, which contributes to the higher mortality rate. The survey carried out by the researchers shows, for example, that biopsies have decreased since 2012 in the North and Northeast. In the Southeast, there was an increase.

According to her, “we need to reduce the distance between diagnosis and treatment more and more” so that the chance of cure is greater.

The delay in diagnosis has also been studied by Zequi. His work published in 2008 indicated that there is a wait of approximately 7 to 8 months between the appearance of an injury and the identification of the disease in public health services.

This slowness influences the success of the treatment. The doctor explains that the disease does not respond well to chemotherapy or radiotherapy, and that surgery to remove the tumor is more indicated. However, if the cancer has already spread, these procedures need to be more radical, such as cases of complete amputation of the organ, which increased by 40% between 2008 and 2018.

Also, the cancer can metastasize to the groin area. In these situations, in addition to amputation of the organ, it is necessary to resort to other surgeries and the patient still suffers from problems such as difficulty in walking and swelling in the legs.

The low level of education is also a factor associated with the disease. According to the survey, people who studied for 12 years had a mortality rate of less than 3%, while those who only studied for up to three years represent almost half of the deaths.

In this way, specialists defend educational campaigns aimed at these vulnerable populations who have little access to information. Zequi mentions, for example, actions to raise awareness about the proper way to sanitize the organ, as this is one of the main ways to prevent the disease.

In addition, faster diagnosis of the disease is essential to reduce the mortality rate in the country. Male vaccination against HPV (Human Papilloma Virus) is also one of the best ways to prevent penile cancer.

Finally, a recurrent follow-up to the urologist is necessary to analyze any suspicion of the disease. “As women do cervical prevention, men also need to do the penis,” says Curado.

Risk factors, prevention and main symptoms of penile cancer

What are the main factors associated with the disease? Low access to health services and poor genital hygiene are listed as major risk factors for the disease. Phimosis, which is the presence of excessive skin on the penis, STIs (sexually transmitted infections) or other premalignant diseases of the penis are also associated with the development of the disease. The practice of zoophilia, according to a study published by Zequi, is also related to the onset of the disease.

What are the main symptoms that can be indicative of the disease? The initial symptoms that can be indicative of penile cancer are excessive secretion in the organ, redness, itching, sores, strong odor, spots and color changes. According to Zequi, in most cases it will not be a tumor, but it is important to seek a urologist for the exact diagnosis.

What are the main ways to prevent penile cancer? Prevention is closely related to the risk factors for the disease. Thus, if phimosis is present, it is important to perform surgery to remove the foreskin, or parents can opt for circumcision of the baby at birth. In the case of STIs, it is always recommended to use a condom to avoid contagion. Vaccination against HPV is also an effective way to prevent the disease from developing. Finally, it is important to pay attention to the proper cleaning of the organ —always clean the genitals with soap and water, pulling the foreskin to exteriorize the glans.