Monday, March 17, 2014

BRITAIN: Penile cancer rises

"Soared" from 1.10 to 1.33 per 100,000/yr, and the mortality rate fell by 20%

Daily Mail
February 18, 2014

The rise of PENIS cancer: Cases soar by 20% amidst fears that symptoms are being misdiagnosed as STDs

  • Number of men diagnosed with disease has risen dramatically in 30 years
  • May be due to changes in sexual behaviour, greater exposure to the human papilloma virus and[/or] decreasing rates of childhood circumcision
  • Men who smoke are also more likely to get penile cancer
by Anna Hodgekiss
The number of men being diagnosed with cancer of the penis has soared by 20 per cent in the last 30 years, according to new figures.

Experts believe the main reasons for the increase may be changes in sexual behaviour, greater exposure to sexually transmitted HPV (human papilloma virus) and[/or] decreasing rates of childhood circumcision.

HPV-related genital warts are associated with a six-fold risk of penile cancer and the incidence of them has rapidly increased in men between 1970 to 2009, with a 30 per cent rise during 2000–2009.

Cancer charities are now urging men to be aware of symptoms of the disease - which are often confused with signs of a sexually transmitted infection.

Penile cancer has a high cure rate if detected early, but some men, such as Nigel Smith, from Wolverhampton, are misdiagnosed.

He was told at a sexual health clinic that he had a genital wart that would go away in time.

It didn't, but rather than seek help, Nigel hid his symptoms from his wife for 12 months by sleeping in their spare bedroom, using his snoring as an excuse.

He was eventually diagnosed with penile cancer in 2011, aged 58, and last year underwent a partial penectomy (partial removal of the penis). He is currently considering reconstructive surgery.

  • A painless lump or ulcer on the penis that doesn't heal
  • Bleeding
  • A red rash under the foreskin
  • Flat growths of brownish colour
  • Difficulty in drawing back the foreskin
  • Unusual smelling discharge from under the foreskin
  • Unexplained change in colour of the skin
  • Swollen lymph nodes in your groin area

The new research, published in the journal Cancer Causes Control, was supported by the male cancer charity Orchid.

Cancer Causes Control. 2013 Dec;24(12):2169-76. doi: 10.1007/s10552-013-0293-y. Epub 2013 Oct 8.
Long-term trends in incidence, survival and mortality of primary penile cancer in England.
Arya M, Li R, Pegler K, Sangar V, Kelly JD, Minhas S, Muneer A, Coleman MP.
Few population-based studies exist of long-term trends in penile cancer. We report incidence and mortality trends in England over the 31 years 1979-2009 and survival trends over the 40 years 1971-2010.
We calculated annual incidence and mortality rates per 100,000 by age and calendar period. We estimated incidence and mortality rate ratios for cohorts born since 1890, and one- and five-year relative survival (%) by age and deprivation category.
A total of 9,690 men were diagnosed with penile cancer during 1979-2009. Age-standardized incidence rates increased by 21 %, from 1.10 to 1.33 per 100,000. Mortality rates fell by 20 % after 1994, from 0.39 to 0.31 per 100,000. Survival analyses included 11,478 men diagnosed during 1971-2010. Five-year relative survival increased from 61.4 to 70.2 %. Five-year survival for men diagnosed 2006-2010 was 77 % for men aged under 60 years and 53 % for men aged 80-99 years. The 8 % difference in five-year survival (66-74 %) between men in the most affluent and most deprived groups was not statistically significant.
The 21 % increase in penile cancer incidence in England since the 1970s may be explained by changes in sexual practice, greater exposure to sexually transmitted oncogenic human papilloma viruses, and[/or] decreasing rates of childhood circumcision. Improvement in survival is likely due to advances in diagnostic, staging and surgical techniques. There is a need for public health education and potential preventative strategies to address the increasing incidence.
PMID: 24101363 [PubMed - in process]

The charity's chief executive, Rebecca Porta, said: 'The research shows that the incidence of this devastating cancer, which currently receives little recognition, is on the increase.

'Unlike other more common cancers, penile cancer is rare and many men feel embarrassed and unable to talk openly about it.


Cancer can develop anywhere in the penis, but the most common places are under the foreskin and on the head (the glans).

The exact cause of penile cancer is unknown, but various factors have been linked to an increased risk.

HPV-related genital warts are associated with a six-fold risk of penile cancer. There are over 100 types of HPV virus and only two strains have been linked with penile cancer. However both these strains are also linked to throat, cervical and anal cancer.

rates of childhood circumcision

A man’s risk of developing cancer of the penis is greater if he smokes. It has been suggested that smoking may act as a co-factor that modulates the risk of progression from HPV infection to premalignant lesions and invasive penile cancer.

Furthermore, the toxic chemicals found in tobacco are excreted in the urine. A build up of these substances under the foreskin may cause changes in the normal healthy cells of the skin, which may lead to cancerous cells developing.

Men who are uncircumcised are also at greater risk. This is because they may find it more difficult to pull back the foreskin enough to clean thoroughly underneath, resulting in poor hygiene. [Or they may just not bother.]

This may lead to a build up of chemical substances that may cause irritation of the skin and lead to cancerous changes.

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