MercoPress. South Atlantic News Agency

High number of amputations to treat penile cancer reported in Brazil

Brazil is one of the three countries with the highest incidence and mortality from penile cancer

A report from the Brazilian Society of Urology (SBU) stated earlier this month that over 6,000 penile amputations have been recorded in the South American country over the past ten years to treat three out of every 10 patients diagnosed with penile cancer. The condition can be avoided with simple hygiene measures and HPV vaccination, the SBU also explained.

“Many people don't even know that it's possible to have penile cancer, they don't go to specialists and end up receiving the diagnosis too late,” stressed Maurício Dener Cordeiro, coordinator of the SBU's Uro-Oncology Department, who admitted that the number of amputations was extremely high.

When identified at an early stage, penile cancer has a high chance of cure and can be treated less aggressively. In these cases, the tumor is restricted to the upper part of the skin and does not reach deeper structures. It is therefore possible to remove only the affected area - i.e. without having to remove the penis.

In the extreme “cases, the urethra is placed in the perineum, and the patient has to start urinating sitting down, which can be a challenge,” Cordeiro admitted while reckoning the procedure can be very damaging to the individual's self-esteem.

Penile cancer is a chronic infection of the foreskin (the skin that covers the glans - the head of the penis), which initially manifests itself as a wound that does not heal and develops into an ulcer or serious lesion. One of the most common causes is not properly sanitizing the area, where fungi and bacteria can proliferate.

According to Cordeiro, the area should be cleaned every day in the shower. ”It's necessary to retract the foreskin, expose the glans, and wash the area with soap and water. Patients with phimosis (difficulty in exposing the glans) have a higher risk of developing the disease and may resort to surgical removal of the foreskin to facilitate hygiene.”

In addition, penile cancer can arise as a result of infection by the HPV virus (human papillomavirus), which affects around 9 million people in Brazil. This is a sexually transmitted virus that causes cervical cancer in women. To avoid contamination, the use of condoms during sexual intercourse is recommended, as well as vaccination against the virus.

Patients need to seek medical help at the earliest in case of wounds that do not heal, or of discharges with a strong odor, thickening, a color change in the skin of the glans, or the presence of nodules in the groin to avoid extreme therapies.

SBU President Luiz Otávio Torres said the Health Ministry's data showed that more than half of the men diagnosed were already at an advanced stage of cancer. Torres also told Agencia Brasil that this is the only type of cancer that can be prevented with soap and water.

The highest incidence of the disease is observed in the North and Northeast regions and is closely related to socioeconomic status. “Socio-economic, because people don't have the habit of sanitizing themselves. This is related to the social aspect. The economic part, too. Those who are better off have access to a lot of information,” said Torres.

The SBU is looking for public hospitals to join the nationwide campaign for free surgeries. Task forces of urologists from the 24 SBU chapters will perform postectomies (removal of the foreskin) in cases where the foreskin does not fully expose the glans and therefore does not allow the penis to be properly sanitized.

“We're trying to run the campaign in as many SBU chapters as possible. We have 29 days in February to try,” said Torres. This month SBU doctors will be answering questions about the disease on the organization's social networks.

“It's not about doing postectomies on everyone,” Torres insisted. The procedure is only indicated when the patient has a true phimosis, i.e. when he pulls the foreskin, the skin, and doesn't expose the glans. If “he has the foreskin, pulls it back, and exposes the glans, there's no need to remove the foreskin. You just have to wash the penis,” the physician also explained.

In cases of people with poor socio-economic conditions, “it's better to remove the foreskin because the glans is exposed,” Torres went on. “Even if he doesn't wash it, he doesn't have the foreskin holding the dirt inside,” he elaborated. In previous editions of the campaign, SBU doctors performed more than 200 postectomies a year.

Torres also explained that most penile cancers occur after the age of 50 and that the incidence was “higher among smokers than among non-smokers,” although rarer cases can be diagnosed in younger men. He also noted HPV infection could be another cause but underlined that the vaccine against that disease was available free of charge from Brazil's Unified Health System (SUS) for girls and boys between the ages of 9 and 14.

Brazil is one of the three countries with the highest incidence and mortality from this type of cancer, second only to countries in sub-Saharan Africa. “It's related to habits and information,” said Torres. According to the Latin American and Caribbean Cancer Code, drawn up with the support of the World Health Organization's International Agency for Research on Cancer and the Pan American Health Organization, penile cancer has the highest incidence in the world in Latin American and Caribbean countries.