What are the risk factors (RF) for penile cancer?

Risk Factors for Penile Cancer

The major risk factors for penile cancer include phimosis, chronic inflammatory conditions, HPV infection, lack of circumcision, tobacco use, poor hygiene, and sexually transmitted diseases, with phimosis carrying a 25-60% increased risk. 1

Demographic and Anatomical Risk Factors

• The median age of penile cancer diagnosis in the United States is 68 years, with increased risk in men older than 50 years 1
• Penile cancer is rare in Western countries (0.4-0.6% of male malignancies) but has higher incidence (up to 10%) in developing countries of Asia, Africa, and South America 1, 2
• The most common sites of occurrence are the glans (34.5%), inner preputial layer, coronal sulcus, and prepuce (13.2%), with shaft involvement in 5.3% of cases 1

Major Modifiable Risk Factors

• Phimosis: Associated with 25-60% increased risk of penile cancer and significantly hinders early detection by preventing proper examination of high-risk areas 1, 3

• Lack of circumcision: Neonatal circumcision is associated with a 3-fold decreased risk of invasive penile cancer 4, 3

  • Countries with high circumcision rates like Israel have the lowest penile cancer incidence (<0.1% of malignancies) 5
  • Circumcision may protect against penile cancer primarily by preventing phimosis 3

• HPV infection: 45-80% of penile cancers are HPV-related, with strong correlation to types 16 and 18 1

  • HPV DNA is detected in 70-100% of penile intraepithelial neoplasia and 40-50% of invasive cancers 4
  • HPV type 16 is found in approximately 69% of penile tumors 3

• Tobacco use: Cigarette smokers are 3.0-4.5 times more likely to develop penile cancer 1

  • Smoking is specifically associated with a 4.5-fold increased risk of invasive penile cancer 3

Inflammatory and Dermatologic Risk Factors

• Lichen sclerosus (balanitis xerotica obliterans): Associated with a 2-9% risk of developing penile carcinoma 1, 6
• Chronic inflammation and balanitis: Significant risk factors for penile cancer development 1, 4
• PUVA therapy: Patients with psoriasis undergoing psoralen plus ultraviolet A phototherapy have 286 times higher risk than the general population 1, 4

Other Risk Factors

• HIV infection: Associated with an 8-fold increased risk, possibly related to higher HPV co-infection rates 1
• Poor hygiene: Contributes to chronic inflammation and infection 1, 6
• History of sexually transmitted diseases: Associated with increased risk 1
• Penile trauma: Can lead to chronic inflammation 1
• Obesity: Identified as a risk factor in contemporary studies 2, 5

Clinical Implications and Prevention

• Early detection is crucial as penile cancer has approximately 50% 5-year survival rate overall, with better outcomes for node-negative disease (>85%) 1

• Preventive measures should include:

  • Treatment of phimosis and chronic inflammatory conditions 4
  • Consideration of neonatal circumcision in high-risk populations 4, 5
  • HPV vaccination programs 2, 4
  • Smoking cessation 4, 3
  • Proper genital hygiene 6
  • Regular examination for men with risk factors, especially those with lichen sclerosus 6

• Patients with lichen sclerosus require long-term follow-up due to risk of malignant transformation 6