Can penile cancer be prevented?

The large variations in penile cancer rates throughout the world strongly suggest that penile cancer is a preventable disease. The best way to reduce the risk of penile cancer is to avoid known risk factors whenever possible.

In the past, circumcision has been suggested as a way to prevent penile cancer. This was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. But in many of those studies, the protective effect of circumcision was no longer seen after factors like smegma and phimosis were taken into account.

Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without known risk factors living in the United States. Men who wish to lower their risk of penile cancer can do so by avoiding HPV infection and not smoking. Those who aren’t circumcised can also lower their risk of penile cancer by practicing good hygiene. Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer.

Genital hygiene

Perhaps the most important factor in preventing penile cancer in uncircumcised men is good genital hygiene. Uncircumcised men need to retract the foreskin and clean the entire penis. If the foreskin is constricted and difficult to retract, a doctor may be able to prescribe a cream or ointment that can be applied to the foreskin to make it easier to retract. If this doesn’t work the doctor may cut the skin of the foreskin in a procedure called a dorsal slit to make retraction easier.

Avoiding HPV infection

All men should do what they can to avoid infection with the human papilloma virus (HPV). In addition to decreasing penile cancer risk, this could have an even bigger impact on the risk of cervical cancer in female partners.

The 2 main factors influencing the risk of genital HPV infection in men are circumcision and the number of sexual partners. Men who are circumcised (have had the foreskin of the penis removed) have a lower chance of becoming and staying infected with HPV. Men who have not been circumcised are more likely to be infected with HPV and pass it on to their partners. The reasons for this are unclear. It may be that after circumcision the skin on the glans (of the penis) goes through changes that make it more resistant to HPV infection. Another theory is that the surface of the foreskin (which is removed by circumcision) is more easily infected by HPV. Still, circumcision does not completely protect against HPV infection - men who are circumcised can still get HPV and pass it on to their partners. The risk of being infected with HPV is also strongly linked to having many sexual partners (over a man’s lifetime).

Signs and symptoms of HPV-related problems:
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.

Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.

Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat.  These include cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils).

RRP is a condition in which warts grow in the throat. These growths can sometimes block the airway, causing a hoarse voice or troubled breathing.

How do people get HPV?
HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop juvenile-onset recurrent respiratory papillomatosis (JORRP).

Condoms (“rubbers”) provide some protection against HPV, but they do not completely prevent infection. Men who regularly use condoms are less likely to be infected with HPV and pass it on to their female partners. Condoms cannot protect completely because they don’t cover every possible HPV-infected area of the body, such as the skin on the genital or anal area. Still, condoms do provide some protection against HPV, and they also protect against HIV and some other sexually transmitted diseases.

Infection with HPV can be present for years without any symptoms; so the absence of visible warts cannot be used to tell if someone has HPV. Even when someone doesn’t have warts (or any other symptom), he (or she) can still be infected with HPV and pass the virus to somebody else.

Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners.

Vaccines have been developed to help prevent infection with some types of HPV. Gardasil® protects against HPV types 6 and 11, which can cause genital warts, and types 16 and 18, which cause some types of cancer. It is currently approved for use in young females and males. Another vaccine, Cervarix®, protects against HPV types 16 and 18 and is approved for use only in young females. The vaccines work best if given before the person starts having sex (and is exposed to HPV). The hope is that HPV vaccines may eventually help reduce the risk of cancers linked to HPV, including penile cancers.

Several studies have shown that male circumcision was associated with a reduced risk of penile HPV infection in men. We also found an inverse association between circumcision and the risk of cervical cancer was significant among women whose male partners engaged in sexual practices known to increase the risk of infection with HPV, such as having had multiple sexual partners.

The assessment of the reliability and validity of self-reported circumcision status has yielded inconsistent results,8,28-30 and potential misclassification of circumcision status with the use of this method has been a major concern in previous studies. One strength of our study is the high rate of accuracy of self-reported circumcision status. Medical examination of the penis, performed in 43 percent of the men, confirmed the self-reported circumcision status in 95 percent of those examined. Inverse associations with the risks of penile HPV infection and cervical cancer were similar when circumcision status was classified according to self-report or medical examination. Likewise, the exclusion of subjects who had not undergone a penile examination (men from Spain and Colombia) did not materially affect the findings.

A potential concern with respect to our study was the fact that 65 percent of the circumcised men were from the Philippines. This result was not unexpected, since mass circumcision sessions are regularly conducted by many organizations in that country and most boys are circumcised before puberty. We performed a secondary analysis excluding men from this study site and found that results were virtually unchanged.

Some studies have reported that genital warts are more common among uncircumcised men than among circumcised men, but other studies have not confirmed these associations. Epidemiologic evidence suggests that the absence of circumcision at birth and the presence of phimosis, poor genital hygiene, genital warts, and HPV infection are risk factors for penile cancer. Other data have suggested that the risk of cervical cancer is reduced among the female partners of circumcised men, but these studies were limited by the small number of circumcised men or the low sensitivity of the methods used to detect HPV DNA.

Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners
N Engl J Med 2002; 346:1105-1112April 11, 2002

Not smoking

Since smoking also increases penile cancer risk, not smoking may lower that risk. Quitting smoking or never starting in the first place is a good way to reduce your risk of many diseases, including penile cancer.

Some men with penile cancer have no known risk factors, so it is not possible to completely prevent this disease.


American Cancer Society

Provided by ArmMed Media