One can prevent penile cancer using preventive measures such as circumcision, smoking cessation, hygiene education and HPV prevention.
Early detection and treatment may increase the likelihood of preservation of the penis and also provide optimal oncological and functional outcomes. However, strategies aimed at primary prevention have clear benefits for individuals and the health economy. One can take many preventive measures including circumcision, smoking cessation, hygiene education and also HPV prevention.
Preventive strategies for penile cancer
Phimosis, hygiene and circumcision
Phimosis is closely linked to the development of cancer of the penis1. This may be due to an underlying cause of phimosis, such as chronic inflammation or poor hygiene due to an inability to retract the foreskin. Lichen sclerosus (LS) is the most common cause of chronic inflammation of phimosis and is also commonly reported in patients with invasive squamous cell carcinoma (SCC), with 28–50% reported. The doctors should instruct patients in daily self-examination and initial clinical examination when new changes occur.
Poor genital hygiene is more commonly seen in uncircumcised men (26%) than in circumcised men (4%)2. In fact, people are largely abandoning the old belief of smegma being carcinogenic. However, during the period when circumcision rates remained stable, the observed reduction in the incidence of penile cancer among certain populations is attributed to improvements in hygiene and sanitation during the same period3. It is easy to propose simple health education programs aimed at improving sanitation, but the cost-effectiveness of disease prevention is difficult to assess because of its unclear etiological role.
In fact, there is a clear association between smoking or chewing tobacco and cancer of the penis4. However, studies have demonstrated a dose-dependent relationship between smoking and penile cancer risk in active smokers and former smokers5. It has, in fact, been shown that current smokers have a significant increase in the risk of aggressive disease development. Therefore, smoking reduction programs have the potential to reduce the risk of invasive penile cancer and cardiovascular and respiratory diseases, in addition to the obvious health and economic benefits of reducing the incidence of lung, bladder, and other smoking-related diseases.
Several types of HPV have been identified in precancerous lesions of the penis. In fact, mostly the high-risk HPV types 16 and 18 do associate with 60–75% of HPV-related precancerous lesions. In recent years, many countries have introduced vaccination programs aimed at preventing primary cervical cancer in females before their first sexual contact. However, the use of vaccination programs limited to females may confer some herd immunity to the male population by reducing the burden of HPV on sexually active individuals. This can in fact, reduce the risk of reinfection in the community and may offer men some protection from HPV-related health problems.
The HPV vaccine are clinically effective in men, as per reports. Randomized, multicenter, placebo-controlled studies have revealed that vaccination with tetravalent vaccine was in fact effective in reducing the incidence of genital warts in 90% of patients without HPV6. However, due to the low incidence of penile cancer in men, it is difficult to evaluate the vaccine efficacy for the prevention of penile intraepithelial neoplasia (peIN) or penile cancer.
- 1.Madsen B, van den, Jensen H, Wohlfahrt J, Frisch M. Risk factors for squamous cell carcinoma of the penis–population-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev. 2008;17(10):2683-2691. doi:10.1158/1055-9965.EPI-08-0456
- 2.O’Farrell N, Quigley M, Fox P. Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study. Int J STD AIDS. 2005;16(8):556-559. doi:10.1258/0956462054679151
- 3.Frisch M, Biggar R, Goedert J. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. J Natl Cancer Inst. 2000;92(18):1500-1510. doi:10.1093/jnci/92.18.1500
- 4.Harish K, Ravi R. The role of tobacco in penile carcinoma. Br J Urol. 1995;75(3):375-377. doi:10.1111/j.1464-410x.1995.tb07352.x
- 5.Daling J, Madeleine M, Johnson L, et al. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer. 2005;116(4):606-616. doi:10.1002/ijc.21009
- 6.Giuliano A, Palefsky J, Goldstone S, et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med. 2011;364(5):401-411. doi:10.1056/NEJMoa0909537