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      Penile Cancer Mortality in Brazil: Are We Making Progress?

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          Abstract

          PURPOSE

          This study aims to analyze the trends in mortality rates from penile cancer (PeC) and the treatment modalities adopted in Brazil over recent years.

          MATERIALS AND METHODS

          Death records for PeC cases (International Classification of Diseases, version 10 C60) and treatment modalities were extracted from the DATASUS database. A joinpoint regression analysis was conducted to examine the data.

          RESULTS

          A total of 7,848 deaths due to PeC were recorded in Brazil between 1996 and 2020. Increasing mortality trends were observed, with an average annual percentage change (AAPC) of 0.91 (0.6-1.2; P < .001). The North and Northeast regions had the highest age-standardized mortality rates (ASMRs) and AAPCs. From 2008 to 2020, the ASMR in the Northeast region remained stable, whereas the North region surpassed it. The Southeast region exhibited a significant downward trend, with an AAPC of –0.91 (–1.3 to -0.5; P < .001). Penile biopsies declined and were more frequent in the southeastern region. A total of 8,498 penile amputations were performed, with 39.4% and 29.1% conducted in the Southeast and Northeast regions, respectively.

          CONCLUSION

          Brazil has experienced increasing mortality trends in PeC over the past 2 decades. Low schooling, married, and young men from the North or Northeast regions represent the majority of deaths. Urgent efforts are needed to enhance the diagnosis and treatment of PeC to prevent and reduce mortality rates in the country.

          Abstract

          Rising penile cancer deaths in Brazil, concentrated in North/Northeast. Interventions are needed, targeting disparities in education, marital status, and age. Regional insights guide health care strategies for improved outcomes.

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          Most cited references19

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          Permutation tests for joinpoint regression with applications to cancer rates

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            Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males.

            Infection with human papillomavirus (HPV) and diseases caused by HPV are common in boys and men. We report on the safety of a quadrivalent vaccine (active against HPV types 6, 11, 16, and 18) and on its efficacy in preventing the development of external genital lesions and anogenital HPV infection in boys and men. We enrolled 4065 healthy boys and men 16 to 26 years of age, from 18 countries in a randomized, placebo-controlled, double-blind trial. The primary efficacy objective was to show that the quadrivalent HPV vaccine reduced the incidence of external genital lesions related to HPV-6, 11, 16, or 18. Efficacy analyses were conducted in a per-protocol population, in which subjects received all three vaccinations and were negative for relevant HPV types at enrollment, and in an intention-to-treat population, in which subjects received vaccine or placebo, regardless of baseline HPV status. In the intention-to-treat population, 36 external genital lesions were seen in the vaccine group as compared with 89 in the placebo group, for an observed efficacy of 60.2% (95% confidence interval [CI], 40.8 to 73.8); the efficacy was 65.5% (95% CI, 45.8 to 78.6) for lesions related to HPV-6, 11, 16, or 18. In the per-protocol population, efficacy against lesions related to HPV-6, 11, 16, or 18 was 90.4% (95% CI, 69.2 to 98.1). Efficacy with respect to persistent infection with HPV-6, 11, 16, or 18 and detection of related DNA at any time was 47.8% (95% CI, 36.0 to 57.6) and 27.1% (95% CI, 16.6 to 36.3), respectively, in the intention-to-treat population and 85.6% (97.5% CI, 73.4 to 92.9) and 44.7% (95% CI, 31.5 to 55.6) in the per-protocol population. Injection-site pain was significantly more frequent among subjects receiving quadrivalent HPV vaccine than among those receiving placebo (57% vs. 51%, P<0.001). Quadrivalent HPV vaccine prevents infection with HPV-6, 11, 16, and 18 and the development of related external genital lesions in males 16 to 26 years of age. (Funded by Merck and others; ClinicalTrials.gov number, NCT00090285.).
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              Human papillomavirus prevalence and type distribution in penile carcinoma.

              Penile carcinoma is an uncommon and potentially mutilating disease with a heterogeneous aetiology. Several risk factors have been established for its development. Human papillomavirus (HPV) infection seems to play an important role in the development of a subset of these carcinomas and its presence is thought to be related to the histological type. HPV prevalence in penile tumours is reported to be associated to a variety of morphological changes. Its determination will provide a better estimate for HPV related cancer burden and its preventable fraction. A systematic and comprehensive literature review of the major penile cancer studies published from 1986 until June 2008 evaluating the HPV prevalence among the different histological types was carried out. 31 studies including 1466 penile carcinomas were reviewed. Global HPV prevalence was 46.9%. Relative contribution was: HPV-16 (60.23%), HPV-18 (13.35%), HPV-6/11 (8.13%), HPV-31 (1.16%), HPV-45 (1.16%), HPV-33 (0.97%), HPV-52 (0.58%), other types (2.47%). Assessment of multiple infections contribution is limited due to study design. Basaloid and warty squamous cell carcinomas were the most frequent HPV-related histological types, but keratinising and non-keratinising subtypes also showed prevalence rates of around 50%. About half of the penile tumours were associated with HPV 16-18 with little presence of other genotypes. Research on the mechanisms behind penile carcinogenesis is warranted. Available HPV vaccines are likely to be effective in penile tumours.
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                Author and article information

                Journal
                JCO Glob Oncol
                JCO Glob Oncol
                go
                GO
                JCO Global Oncology
                Wolters Kluwer Health
                2687-8941
                2024
                29 February 2024
                29 February 2024
                : 10
                : e2300303
                Affiliations
                [ 1 ]Department of Urology, Fundação Antônio Prudente, A.C. Camargo Cancer Center, São Paulo, Brazil
                [ 2 ]Department of Urology, Hospital Santa Catarina, São Paulo, Brazil
                [ 3 ]Group of Epidemiology and Statistics on Cancer, International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
                [ 4 ]Department of Urology, Hospital São Camilo Pompeia, São Paulo, Brazil
                [ 5 ]National Institute for Science and Technology in Oncogenomics and Therapeutic Innovation, São Paulo, Brazil
                [ 6 ]Department of Surgery, Division of Urology, Graduate School, São Paulo Federal University, São Paulo, Brazil
                Author notes
                Thiago Camelo Mourão, MD, PhD; e-mail: thiago.mourao@ 123456accamargo.org.br .
                Author information
                https://orcid.org/0000-0003-4800-6009
                https://orcid.org/0000-0002-5054-6568
                https://orcid.org/0000-0002-5978-3279
                https://orcid.org/0000-0001-7747-1239
                https://orcid.org/0000-0001-5989-9848
                https://orcid.org/0000-0003-1897-8085
                Article
                GO.23.00303 00047
                10.1200/GO.23.00303
                10914237
                38422465
                347f055e-6a0d-4b8d-a05f-1351fa51ea95
                © 2024 by American Society of Clinical Oncology

                Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                : 26 August 2023
                : 23 November 2023
                : 10 January 2024
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 24, Pages: 10
                Categories
                ORIGINAL REPORTS
                Genitourinary Cancer
                Custom metadata
                TRUE

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