title: Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma.
abstract: OBJECTIVE
  The incidence of penile cancer is four times higher in Paraguay than in the United States or Europe. There are no adequate scientific explanations for this geographical variation. The goal of this study was to evaluate the interplay among risk factors, morphology of the primary tumor, and HPV status.
  
  
  METHODS
  Information on socioeconomic status, education level, habits, and sexual history was obtained in 103 Paraguayan patients with penile cancer. All patients were then treated by surgery, and specimens were evaluated histopathologically.
  
  
  RESULTS
  Patients usually dwelled in rural/suburban areas (82%), lived in poverty (75%), had a low education level (91%), and were heavy smokers (76%). Phimosis (57%), moderate/poor hygienic habits (90%), and history of sexually transmitted diseases (74%) were frequently found. Patients with >10 lifetime female partners had an odds ratio of 3.8 (95% CI 1.1, 12.6; P-trend = .03) for presenting HPV-positive tumors when compared to patients with <6 partners. However, this trend was not significant when the number of sexual partners was adjusted for age of first coitus and antecedents of sexually transmitted diseases. HPV-related tumors (found in 36% of the samples) were characterized by a warty and/or basaloid morphology and high histological grade in most cases.
  
  
  CONCLUSIONS
  In our series, patients with penile cancer presented a distinctive epidemiologic and pathologic profile. These data might help explaining the geographical differences in incidence and aid in the design of strategies for cancer control in Paraguay.
authors: Instituto de Patología e Investigación, Asunción, Paraguay. achaux1@jhmi.edu
authors: Alcides
authors: A
authors: Chaux
authors: George J
authors: GJ
authors: Netto
authors: Ingrid M
authors: IM
authors: Rodríguez
authors: José E
authors: JE
authors: Barreto
authors: Judith
authors: J
authors: Oertell
authors: Sandra
authors: S
authors: Ocampos
authors: Hugo
authors: H
authors: Boggino
authors: Ricardo
authors: R
authors: Codas
authors: F
authors: F
authors: Xavier Bosch
authors: Silvia
authors: S
authors: de Sanjose
authors: Nubia
authors: N
authors: Muñoz
authors: Allan
authors: A
authors: Hildesheim
authors: Antonio L
authors: AL
authors: Cubilla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002944:Circumcision, Male; D015897:Comorbidity; D004522:Educational Status; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D010239:Paraguay / Q000453:epidemiology; D010412:Penile Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D010413:Penis / Q000473:pathology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012923:Social Class