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Penile cancer is a relatively rare genital malignancy whose incidence and mortality are rising in many countries.
This study aims to assess the recent incidence and mortality patterns and incidence trends of penile cancer.
The age-standardized incidence and mortality rates (ASIR and ASMR, respectively) of penile cancer in 2020 were estimated from the Global Cancer Registries (GLOBOCAN) database. Incidence trends of penile cancer from 1973 to 2012 were assessed in 44 populations from 43 countries using the Cancer Incidence in Five Continents plus (CI5
Globally, the estimated ASIR and ASMR of penile cancer were 0.80 (per 100,000) and 0.29 (per 100,000) in 2020, equating to 36,068 new cases and 13,211 deaths in 2020, respectively. There was no significant correlation between the ASIR (
Although the developing countries still bear the higher incidence and mortality of penile cancer, the incidence is on the rise in most European countries. To mitigate the disease burden resulting from penile cancer, measures to lower the risk for penile cancers, including improving penile hygiene and male human papillomavirus vaccination, may be warranted.
Penile cancer is rare and can occur anywhere on the penis, although most cases arise from the squamous epithelium of glans, coronal sulcus, and prepuce or foreskin. About 95% of penile cancer is classified as squamous cell carcinoma but penile cancer also includes sarcoma, melanoma, and basal cell carcinoma [
There are many causes of penile cancer. Factors that increase the risk include phimosis, poor personal hygiene, and persistent high-risk human papillomavirus (HPV) infection [
The incidence of penile cancer has been increasing in many areas in the past few decades [
We aimed to examine the geographical variations in incidence and mortality patterns of penile cancer among 185 countries in 2020 and the long-term incidence trends in 43 countries with 44 populations during the period between1973 and 2012. Our objective is to inform future research and assist policymakers in adopting sound cancer control initiatives.
The estimated data were extracted from the GLOBOCAN Database from the International Agency for Research on Cancer (IARC) [
Four levels of HDI were used to further assess the cancer burden according to a binary proxy of development (low and medium HDI vs high and very high HDI) in GLOBOCAN 2020. The incidence data of Denmark, Finland, Iceland, Norway, and Sweden were extracted from the NORDCAN database for the years 1953-2016 [
The age-standardized rates were calculated using the World standard population [
The global estimated ASIR of penile cancer was 0.8 (per 100,000) in 2020, with estimates indicating 36,068 newly diagnosed cases (
Estimates suggest that 13,211 men with penile cancer died in 2020 globally, corresponding to an ASMR of 0.29 cases per 100,000 (
Both ASIR and ASMR in low- and middle-income countries were nearly twice as those in high-income countries (
Estimated age-standardized incidence rate (world) in 2020 for penile cancer (A) and estimated age-standardized mortality rate (world) in 2020 for penile cancer (B). (GLOBOCAN 2020 [
Distribution between (A) age-standardized incidence and (B) mortality rates of penile cancer and HDI (GLOBOCAN 2020). HDI: human development index.
Among 44 populations from 43 countries included in the analysis, the highest ASIR of penile cancer between 2008 and 2012 was in Uganda (2.2 per 100,000), followed by Brazil (2.1 per 100,000), Thailand (1.4 per 100,000), and India (1.4 per 100,000) (
Age-standardized (world standard population) rates of penile cancer incidence, 2008-2012. SEER: Surveillance, Epidemiology, and End Results Program.
The trends in the ASIR of penile cancer between one year and another in 44 populations from 43 countries are displayed in
ASIRs of penile cancer in 5 out of 40 populations, including 3 from Northern America and 2 from Asia, significantly decreased. These decreases were in the Philippines (–2.9, 95% CI –4.5 to –1.2;
ASIRs of penile cancer in other parts of Europe, apart from France and Switzerland, increased over the 15-year period (1998-2012;
Age-standardized incidence rates of penile cancer. (A) Trends in penile cancer incidence increasing. (B) Trends in penile cancer incidence decreasing. aRegional data.
International variation in carcinoma of penis incidence rates.
Countries | Registries | Database source | Period | APCa | AAPC (%)b | AAPC (95% CI) |
Austria | National | [ |
1993-2012 |
|
0.9 | –0.7 to 2.6 |
Australia | National | [ |
1982-2016 |
|
0.1 | –0.5 to 0.6 |
Brazil | Goiania | CI5 |
1993-2012 |
|
–0.0 | –5.8 to 6.1 |
Bulgaria | National | CI5 |
1998-2012 |
|
1.3 | –0.5 to 3.1 |
Canada | Alberta, British Columbia, Manitoba, Newfoundland, Nova Scotia, Ontario, Prince Edward Island, Saskatchewan | CI5 |
1983-2012 |
|
–0.7d | –1.2 to –0.2 |
China | Shanghai | CI5 |
1988-2012 |
|
1.6d | 0.1 to 3.2 |
Colombia | Cali | CI5 |
1983-2012 |
|
1.8 | –0.3 to 4.0 |
Costa Rica | National | CI5 |
1982-2011 |
|
0.2 | –1.1 to 1.6 |
Croatia | National | [ |
1988-2017 |
|
3.6d | 2.2 to 5.0 |
Cyprus | National | CI5 |
1998-2012 |
|
4.6d | 0.2 to 9.1 |
Czech Republic | National | [ |
1977-2018 |
|
2.0d | 1.6 to 2.4 |
Denmark | National | NORDCANe database | 1953-2016 |
|
0.1 | –0.1 to 0.4 |
Ecuador | Quito | CI5 |
1991-2011 |
|
–1.3 | –6.6 to 4.4 |
Estonia | National | CI5 |
1983-2012 |
|
2.2d | 0.4 to 4.0 |
Finland | National | NORDCAN database | 1953-1982 | –1.9d |
|
–3.1 to –0.7 |
NORDCAN database | 1982-2015 | 1.7d |
|
0.7 to 2.7 | ||
NORDCAN database | 1953-2015 |
|
0.0 | –0.4 to 0.5 | ||
France | Bas-Rhin, Calvados, Doubs, Isere | CI5 |
1979-2012 |
|
–0.5 | –1.5 to 0.5 |
Germany | Saarland | CI5 |
1973-2012 |
|
0.9 | –0.9 to 2.7 |
India | Chennai | CI5 |
1983-2012 |
|
–2.5d | –3.4 to –1.6 |
Ireland | National | CI5 |
1994-2012 |
|
–0.1 | –1.8 to 1.6 |
Israel | National | CI5 |
1988-2012 |
|
7.2d | 3.4 to 11.1 |
Italy | Biella, Naples, Parma, Romagna, Ragusa | CI5 |
1986-2012 |
|
2d | 0.7 to 3.2 |
Japan | Miyagi Prefecture, Nagasaki, Osaka Prefecture | CI5 |
1973-1986 | 1.4 |
|
–1.9 to 4.8 |
CI5 |
1986-1992 | –10.6 |
|
–22.3 to 2.9 | ||
CI5 |
1992-2012 | 1 |
|
–0.7 to 2.8 | ||
CI5 |
1973-2012 |
|
–0.7 | –3.2 to 1.8 | ||
Korea | Busan, Seoul, Gwangju, Incheon | CI5 |
1993-2012 |
|
–3.1 | –6.1 to 0.1 |
Lithuania | National | CI5 |
1993-2012 |
|
2.6d | 0.8 to 4.4 |
The Netherlands | National | CI5 |
1989-2012 |
|
1.3d | 0.5 to 2.1 |
New Zealand | National | [ |
1983-2009 | –1.3d |
|
–2.6 to –0.1 |
[ |
2009-2018 | 6.1 |
|
–0.3 to 12.9 | ||
[ |
1983-2018 |
|
0.5 | –1.2 to 2.3 | ||
Norway | National | NORDCAN database | 1953-2016 |
|
0.6d | 0.2 to 1.0 |
Philippines | Manila | CI5 |
1983-2012 |
|
–2.9d | –4.5 to –1.2 |
Poland | Kielce | CI5 |
1998-2012 |
|
1.7 | –6.6 to 10.9 |
Russia | National | [ |
1998-2019 |
|
1.6d | 1.1 to 2.0 |
Slovakia | National | CI5 |
1971-2012 |
|
1.4d | 0.6 to 2.1 |
Slovenia | National | CI5 |
1983-2012 |
|
–0.5 | –1.9 to 0.9 |
Spain | Basque, Tarragona, Granada, Girona | CI5 |
1988-2012 |
|
0.2 | –0.9 to 1.4 |
Sweden | National | NORDCAN database | 1960-1989 | –0.5 |
|
–1.1 to 0.1 |
NORDCAN database | 1989-2016 | 1.0d |
|
0.3 to 1.6 | ||
NORDCAN database | 1960-2016 |
|
0.2 | –0.1 to 0.4 | ||
Switzerland | Geneva, Neuchatel, Vaud | CI5 |
1988-2012 |
|
–0.2 | –2.3 to 1.9 |
Thailand | Chiang Mai | CI5 |
1983-1988 | 13.8 |
|
–4.1 to 35.0 |
CI5 |
1988-2012 | –3.4d |
|
–4.9 to –1.8 | ||
CI5 |
1983-2012 |
|
–0.6 | –3.6 to 2.5 | ||
Uganda | Kampala | CI5 |
1993-2004 | 1.2 |
|
–7.9 to 11.1 |
CI5 |
2004-2007 | –46.8 |
|
–86.7 to 112.9 | ||
CI5 |
2007-2012 | 53.3d |
|
12.4 to 109 | ||
CI5 |
1993-2012 |
|
2 | –17.8 to 26.5 | ||
United Kingdom | East England, East Midlands, London, Northeast, Northern Ireland, Northwest, Scotland, Southeast, Southwest, West Midlands, Yorkshire-Humber | CI5 |
1995-2012 |
|
1.6d | 0.9 to 2.3 |
USA Black | SEERf (9 registries): Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget Sound, and Utah | CI5 |
1978-2012 |
|
–0.8c | –1.4 to –0.3 |
USA White | SEER (9 Registries): Atlanta, Connecticut, Detroit, Hawaii, Iowa, New Mexico, San Francisco-Oakland, Seattle-Puget Sound, and Utah | CI5 |
1978-2012 |
|
–1.9c | –3.1 to –0.6 |
aAPC: annual percentage change.
bAAPC: average annual percentage change.
cCI5
dStatistically significant (
eNORDCAN: Nordic Cancer Registries.
fSEER: Surveillance, Epidemiology, and End Results Program.
Average annual percentage change (AAPC) of penile cancer incidence in the recent 15 years (1998-2012). astatistically significant; bregional data (incidence).
This study comprehensively describes the global pattern and incidence trend of penile cancer. We found that the higher incidence and mortality of penile cancer remain centered in developing settings, such as Southern Africa, South Asia, and South America. In examining temporal trends in incidence, we found that the ASIRs of penile cancer have increased in 15 of 40 populations, 13 of which were in Europe, and decreased in 5 populations.
Although penile cancer is a rare disease, its incidence varies greatly in different regions of the world. In this study, the highest ASIRs of penile cancer occurred in Southern Africa, especially in Eswatini (ASIR: 7.0 per 100,000) and Uganda (ASIR: 4.6 per 100,000) [
We found a significantly increasing trend in the ASIR of penile cancer among most European countries (Italy, the Netherlands, Croatia, Czech Republic, Slovakia, and Russia) during the study period, especially in Northern Europe (United Kingdom, Lithuania, Norway, Estonia, and Cyprus). Consistent with our results, an increasing trend in the ASIR of penile cancer was previously observed in Norway (1956-2015) [
There are many reasons for the increasing trend in the ASIR of penile cancer observed in the aforesaid countries. Increased exposure of the population to HPV and decreasing rates of circumcision in children may play an important role. Childhood circumcision has a strong protective effect against penile cancer [
We found that ASIR decreased in Brazil, Canada, the United States, and most Asian countries, including India, Japan, Korea, Philippines, and Thailand. Although male HPV vaccines are available in Brazil, the United States, and Canada, vaccination would not have had sufficient time to influence the rates of penile cancer in these countries. The major determinant of male circumcision in India is religion: Muslims practice male circumcision for cultural reasons, whereas the predominantly Hindu population does not. This hinders the national promotion of circumcision and is linked to the lower popularity of circumcision [
The incidence trend of penile cancer observed in this study is similar to other long-lag HPV-related cancers, such as vulvar cancer and anal cancer [
The results in our study are enhanced by using 3 data sources (GLOBOCAN, CI5
Further research is, however, needed to explain the observed regional differences. As a large proportion of penile cancer is attributable to HPV, the efficacy of HPV vaccines in high-risk groups should be assessed as soon as possible. Future research should also continue to explore the association of risk factors with prognosis in patients with penile cancer and to follow the evolution of incidence and survival of this cancer.
In conclusion, this study provides a comprehensive update on the global patterns and trends in the incidence of penile cancer. While the higher incidence and mortality of penile cancer remain in some developing countries, these have significantly increased in most European populations studied, but have also decreased in a few countries. Although there are many causes of penile cancer, HPV infection, poor penile hygiene, and lack of circumcision may play important roles. Improving penile hygiene and promoting the widespread use of male HPV vaccines should be part of prevention programs for penile cancer in the future.
Estimated new cases number and age-standardized incidence rates for penile cancer.
Estimated death cases number and age-standardized mortality rates for penile cancer.
average annual percentage change
annual percentage change
age-standardized incidence rate
age-standardized mortality rate
Cancer Incidence in Five Continents
Global Cancer Registries
Human Development Index
human immunodeficiency virus
human papillomavirus
International Agency for Research on Cancer
locally weighted regression
Nordic Cancer Registries
Surveillance, Epidemiology, and End Results Program
The authors gratefully acknowledge all cancer registries and their staff who have contributed in sharing their data needed for this study. We thank Qianglin Fang, Chongguang Yang, Yawen Jiang, Siyang Liu, Huicui Meng, Jinqiu Yuan, and Yiqiang Zhan for their comments during the preparation of this manuscript. This study was supported by the Natural Science Foundation of China Excellent Young Scientists Fund (82022064), Natural Science Foundation of China International/Regional Research Collaboration Project (72061137001), Natural Science Foundation of China Young Scientist Fund (81703278), the National Science and Technology Major Project of China (2018ZX10721102), the Sanming Project of Medicine in Shenzhen (SZSM201811071), the High Level Project of Medicine in Longhua, Shenzhen (HLPM201907020105), the National Key Research and Development Program of China (2020YFC0840900), the Shenzhen Science and Technology Innovation Commission Basic Research Program (JCYJ20190807155409373), Special Support Plan for High-Level Talents of Guangdong Province (2019TQ05Y230), and the Fundamental Research Funds for the Central Universities (58000-31620005). All funding parties did not have any role in the design of the study or in the explanation of the data.
The data that support the findings of this study are available from the corresponding author, HZ, upon reasonable request.
CKF owns shares in CSL Biotherapies. The other authors declare no conflicts of interest related to this work.