Phimosis, Lichen Sclerosus, Smoking, Poverty, Sexually Related Epidemiological Factors and Late Diagnosis Are Prevalent among Patients with Penile Cancer in Paraguay.
Antonio L Cubilla, Alcides Chaux, Ingrid M Rodriguez, Jose E Barreto, George J Netto, Francisco Xavier Bosch, Silvia de Sanjose, Nubia Munoz, Allan Hildesheim. Instituto de Patología e Investigación, Asuncion, Paraguay; Johns Hopkins University, Baltimore, MD; Instituto Catalán Oncológico, Barcelona, Spain; CIBER Epidemiologia y Salud Pública, Barcelona, Spain; National Cancer Institute, Bethesda, MD
Background: The incidence of penile carcinoma in Paraguay is among the highest worldwide (4x100.000). Penile cancer has been related to environmental factors, including human papillomavirus (HPV) infections. This study was designed to generate epidemiological data to guide future studies and a cancer control program.
Design: A questionnaire (prospectively administered to 103 patients referred to a Penile Cancer Center between 1993-2007) obtained information on age, residence, education, income, smoking, hygiene and sexual habits, and history of sexually transmitted diseases. Medical record abstraction collected information about tumor site and foreskin features. All cases were pathologically proven invasive penile carcinomas.
Results: Median age was 62 years. Tumors were large, involving multiple compartments in 56% of cases. Tumors exclusive of glans, foreskin or skin of the shaft were less frequent (32%, 11%, and 1%). Phimosis was detected in 57% of cases and the major cause was lichen sclerosus, present in 74% of such patients. Patients lived in either semi rural or rural regions (83%) and were typically moderate to heavy smokers (76%). A history of STD was present in 74% of the cases; 58% of the patients had more than 10 life-time female sexual partners. Minimal education and poverty were characteristic (91% and 75%). Histologically, 102 cases were squamous cell carcinomas (SCC) and 1 case was a clear cell carcinoma; 67% of carcinomas showed an associated lichen sclerosus. Evidence of HPV infection (evaluated by SPF-10 PCR in formalin-fixed, paraffin-embedded tissues in 86% of all cases) was found in 36% of tumors. Twenty-four percent of all patients received inguinal dissection and nodal metastasis was present in 72% of such cases.
Conclusions: Penile cancer patients in Paraguay are poorly educated smokers of low socio-economic conditions, living in semi-rural or rural areas of the country. They frequently report history of sexually transmitted diseases and a high number of female partners. Phimosis and lichen sclerosus are prevalent. Their tumors are typically large and locally advanced, with a high regional metastatic rate. These data may guide planning of a penile cancer public health control program in Paraguay.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 89, Tuesday Afternoon