Penile cancer: 6,500 amputations in Brazil in a decade – BBC News

In 2018, Brazilian retiree João sought medical attention after discovering a wart on his penis.

“I started going to medical clinics to find out what it was, but all the doctors told me it was caused by excess skin and prescribed medications,” the man recalls 63 years old.

Despite medication, the wart continued to grow. This began to take a toll on his marriage and João and his wife’s sex life declined. “We were like brothers and sisters,” he admits. He was determined to find out what was going on.

For five years, João, not his real name, saw specialists who prescribed more medications and ordered more biopsies. “Nothing has solved the problem,” he says.

Then, in 2023, he was diagnosed: João suffered from penile cancer.

“For my family, it was a very unpleasant surprise, especially since part of my penis had to be amputated. I felt like I had been decapitated,” he says.

“It’s a type of cancer that you can’t talk about with people because it might turn into a joke.”

Penile cancer is rare, but its incidence and mortality rate are increasing worldwide.

According to the latest studies, Brazil, where João comes from, has one of the highest incidence rates, at 2.1 per 100,000 men.

Between 2012 and 2022, 21,000 cases have been reported, according to the Brazilian Ministry of Health. This has led to more than 4,000 deaths and, over the past decade, more than 6,500 amputations, an average of one every two days.

Maranhão, Brazil’s poorest state, has the highest incidence rate in the world, 6.1 per 100,000 men.

Symptoms of penile cancer often start with a sore on the penis that doesn’t heal and a smelly discharge. Some people also experience bleeding and changes in color of the penis.

When detected early, the chances of recovery are high with treatments such as surgical removal of the lesion, radiotherapy and chemotherapy.

But if left untreated, partial or total amputation of the penis, and possibly other nearby genitals such as the testicles, may become necessary.

João underwent a partial amputation in January and says it was a difficult time.

“It’s something you never imagine could happen to you, and when it happens, you can’t just tell people,” he says.

“I was terrified of surgery, but there was no other alternative. The feeling in the first weeks after the operation was one of sadness, I can’t deny that. Not having part of your penis is horrible.”

Some patients undergo a life-changing total amputation.

Thiago Camelo Mourão from the Department of Urology at the AC Camargo Cancer Center in São Paulo says: “In cases of partial amputation, urine continues to come out through the penis.

“However, in cases of total amputation, the urethral orifice may be displaced towards the perineum, between the scrotum and anus, forcing the patient to urinate while sitting on the toilet.”

Mauricio Dener Cordeiro of the Brazilian Society of Urology says persistent infection with human papillomavirus (HPV), the name given to a common group of viruses, is “one of the main risk factors.” HPV can be transmitted during sexual intercourse and, in some cases, can lead to cancers, particularly of the mouth and penis.

He says: “Mass vaccination against HPV is essential because of its high effectiveness in preventing associated lesions,” but he adds that vaccination rates in Brazil are below the level needed to be truly effective.

“In Brazil, despite the availability of the vaccine, the HPV vaccination rate remains low for girls – reaching only 57% – and for boys it does not exceed 40%,” he says. “The ideal coverage to prevent illness is 90%.”

He believes that misinformation about the vaccine, unfounded doubts about its effectiveness and the lack of vaccination campaigns have contributed to this low vaccination rate.

According to the UK National Health Service (NHS) website, smoking can also increase the risk of penile cancer. It also states that you may be more likely to develop penile cancer if you “have difficulty pulling back your foreskin (the skin covering your penis) to keep your penis clean (a condition called phimosis).”

“When a man does not expose the glans and properly clean the foreskin, it produces a discharge that builds up,” says Dr. Cordeiro. “This creates a very favorable environment for bacterial infections.

“If this happens repeatedly, it becomes a risk factor for the tumor to appear.”

But Brazil is not the only country where penile cancer is on the rise. According to the latest research, the number of cases is increasing worldwide.

In 2022, the journal JMIR Public Health and Surveillance published the results of a large-scale analysis involving the latest data from 43 countries.

Between 2008 and 2012, the highest incidence of penile cancer was found in Uganda (2.2 per 100,000), followed by Brazil (2.1 per 100,000) and Thailand (1.4 per 100 000). The lowest was recorded in Kuwait (0.1 per 100,000).

“Although developing countries still experience higher incidence and mortality from penile cancer, incidence is increasing in most European countries,” found the team of researchers led by Leiwen Fu and Tian Tian from Sun Yat-Sen University in China.

They reported that England had seen an increase in penile cancer, from 1.1 to 1.3 per 100,000 between 1979 and 2009, and that in Germany, cases had increased by 50%, from 1 .2 to 1.8 per 100,000 between 1961 and 2012.

These numbers will only increase, according to the Global Cancer Registries prediction tool. It is estimated that by 2050, the global incidence of penile cancer will increase by more than 77%.

This change can be largely attributed to the aging population, according to experts, who say the highest incidence occurs among men in their 60s.

Dr. Cordeiro says: “Penile cancer is a rare but also highly preventable disease.”

He said using condoms during sex and surgery to remove the foreskin in cases of phimosis could help reduce the risk of penile cancer.

Neil Barber, clinical lead for urology at Frimley Health NHS Foundation Trust, adds: “Penile cancer is almost unheard of in the circumcised population. Poor hygiene and infections under the foreskin, as well as conditions like phimosis that make it difficult for the foreskin to retract. and maintaining good hygiene are risk factors. This is linked to higher overall infection risks.”

“Established risk factors also include unprotected sex, particularly not using condoms, with poor hygiene further increasing risks through this route.”

João is currently waiting for the final results of his tests, which he will receive later this year. “I am convinced that these tests will show that I will be cured,” he said.

“Now, after the amputation, the pain is gone and I feel much better. But I will have to live with a partially amputated penis for the rest of my life.”

According to Cancer Research UK, more than 90% of men diagnosed with penile cancer that has not spread to nearby lymph nodes survive for five years or more.

Additional reporting by Rone Carvalho, BBC Brasil