6,500 amputees in Brazil in ten years

In 2018, Brazilian pensioner João sought medical help after discovering warts on his penis.

“I started going to medical clinics to find out the cause, but all the doctors told me it was due to excess skin and prescription drugs,” the 63-year-old recalled.

Despite medical treatment, the warts continue to grow. This began to take its toll on his marriage, and João and his wife’s sex life declined. “We’re like brothers and sisters,” he admits. He was determined to find out what happened.

For five years, João (not his real name) kept going to specialists who prescribed more drugs and ordered new biopsies. “Nothing can solve this problem,” he said.

Then, in 2023, he was diagnosed with penile cancer in João.

“It was a very unpleasant surprise for my family, not least because I had to have part of my penis amputated. I felt like I was being decapitated,” he said.

“This is a cancer you can’t talk about with people because it might turn into a joke.”

Penile cancer is rare, but incidence and mortality are increasing around the world.

João’s native Brazil has one of the highest rates, with 2.1 cases per 100,000 men, according to new research.

According to Brazil’s Ministry of Health, 21,000 cases were reported between 2012 and 2022. This has resulted in more than 4,000 deaths and more than 6,500 amputations over the past decade – an average of one amputation every two days.

Maranhão, Brazil’s poorest state, has the highest incidence rate in the world at 6.1 cases per 100,000 men.

Symptoms of penile cancer usually begin with sores on the penis that won’t heal and strong-smelling discharge. Some people also experience bleeding and discoloration from their penis.

If detected early and treated with surgical removal of lesions, radiotherapy, and chemotherapy, the chances of recovery are high.

But if left untreated, the penis may need to be partially or completely removed, and it may even require the removal of other nearby reproductive organs, such as the testicles.

Joao underwent a partial amputation in January and said it was a difficult time.

“It’s something you never think will happen to you, and when it happens, you can’t just go around telling people,” he said.

“I was terrified of the surgery but there was no other option. The feeling in the first few weeks after the surgery was sad, I can’t deny it. Not having part of the penis was terrifying.”

Some patients undergo complete amputation, which changes their lives.

Thiago Camelo Mourão, Department of Urology, AC Camargo Cancer Center, São Paulo, said: “In cases of partial amputation, urine continues to pass through the penis.

“However, in a complete amputation, the urethral opening may be relocated to the perineum, between the scrotum and anus, requiring the patient to urinate while sitting on the toilet.”

Persistent infection with human papillomavirus (HPV), the name for a group of common viruses, is “one of the main risk factors,” said Mauricio Dener Cordeiro of the Brazilian Urological Society. HPV can be spread during sex and, in some cases, can cause cancer, including oral and penile cancer.

“Mass vaccination against HPV is crucial because it is very effective in preventing associated lesions,” he said, but added that vaccination rates in Brazil were below the levels needed to be truly effective.

He said: “In Brazil, despite the availability of the vaccine, HPV vaccination coverage among girls remains low, reaching only 57%, while that among boys does not exceed 40%. The ideal coverage to prevent the disease is 90% .

He believes misinformation about the vaccine, unfounded doubts about its effectiveness and a lack of vaccination campaigns have contributed to low uptake.

According to the British National Health Service (NHS) website, Smoking also increases the risk of penile cancer. It also says you may be more likely to develop penile cancer if you “have problems pulling back the foreskin (the skin covering the penis) to keep it clean (a condition called phimosis).”

“When a man doesn’t expose his glans and doesn’t clean his foreskin properly, a buildup of discharge can occur,” says Dr. Cordeiro. “This creates a very favorable environment for bacterial infection.

“If this happens repeatedly, it becomes a risk factor for the development of tumors.”

But Brazil isn’t the only country where rates of penile cancer are rising. According to the latest research, the number of cases is increasing globally.

In 2022, the journal “JMIR Public Health and Surveillance” published the results of a large-scale analysis involving the latest data from 43 countries.

The study found that between 2008 and 2012, the highest incidence of penile cancer was in Uganda (2.2 per 100,000 people), followed by Brazil (2.1 per 100,000 people) and Thailand (2.1 per 100,000 people). 1.4 people). The lowest is in Kuwait (0.1 per 100,000 people).

A research team led by Leiwen Fu and Tian Tian of Sun Yat-sen University in China found that “although incidence and mortality from penile cancer remain high in developing countries, incidence rates are increasing in most European countries.”

They report that rates of penile cancer increased in the UK, from 1.1 to 1.3 cases per 100,000 people between 1979 and 2009, while in Germany from 1.2 cases per 100,000 people between 1961 and 2012 This increased to 1.8 cases, a 50% increase.

According to the Global Cancer Registry Forecast Tool, these numbers are only going to get higher. It is estimated that by 2050, the global incidence of penile cancer will increase by more than 77%.

Experts say the change is largely due to the aging population, with the highest rates among men in their 60s.

“Penile cancer is a rare but highly preventable disease,” Dr. Cordeiro said.

He suggested that using condoms during sex, as well as circumcision surgery in cases of phimosis, could help reduce the risk of penile cancer.

Neil Barber, clinical lead for urology at Frimley Health NHS Foundation Trust, added: “Penile cancer is almost unheard of in circumcised people. Poor hygiene, infection under the foreskin, As well as conditions such as phimosis that make it difficult to retract the foreskin and maintaining good hygiene are risk factors, which are associated with a higher overall risk of infection.”

“Established risk factors also include unprotected sex, particularly without condoms, and poor hygiene further increases the risk in this pathway.”

Joao is currently awaiting the latest test results, which he will receive later this year. “I believe these tests will show that I will be cured,” he said.

“Now, after the amputation, the pain is gone and I feel better. But I will have to live with a partially amputated penis for the rest of my life.”

According to Cancer Research UKMore than 90 percent of men diagnosed with penile cancer that has not spread to nearby lymph nodes survive five years or more.

Additional reporting by Rone Carvalho, BBC Brazil