Penile Cancer Epidemiology and Risk Factors

A Contemporary Review

Antoin Douglawi; Timothy A. Masterson


Curr Opin Urol. 2019;29(2):145-149. 

In This Article

Exposure Related Factors

Smoking is a well recognized risk factor in many types of malignancies and multiple studies have shown a correlation between smoking and penile cancer. Reports from the early 1990s showed a two-fold increase of penile SqCC in smokers.[45] A study of 230 patients in Brazil noted that more than 50% of penile patients with SqCC were smokers.[7,46] Follow up studies with age-matched controls in India reported a dose–response relationship associated with smoking and implicated both chewing tobacco and snuff as risk factors.[47] More recently, a case–control study in Los Angeles showed a 2.4-fold increase in patients who ever smoked with a higher incidence in current smokers (OR 3.1).[48]

Marijuana use has become more widespread in recent years with more states in the United States considering legalization for medical or recreational purposes. Although Marijuana smoke theoretically confers similar exposure to that of tobacco, a review of case–control studies did not show any increased penile SqCC risk.[49] Other studies showed a significant association with tobacco smoke (OR 3.2) but a weak association with Marijuana smoking (OR 1.5) which was not statistically significant.

Other forms of carcinogen exposure have also been implicated in penile SqCC development. PUVA is a form of photochemotherapy, which is used for chronic plaque psoriasis.[5] The carcinogenesis mechanism is poorly understood as it was noted that even nonexposed skin was at risk. A prospective study of 892 patients with psoriasis treated with PUVA revealed a morbidity ratio of 95.7 compared to the general population. Men that had high-dose exposure had a 286-fold increase in risk of SqCC compared to nonexposed patients.[50] A more recent systematic review of 49 studies noted an increased risk even at low doses. The risk was found to increase linearly with the number of doses and persist after treatment was stopped.[51]