title: Racial Disparities Differ for African Americans and Hispanics in the Diagnosis and Treatment of Penile Cancer.
abstract: OBJECTIVE
  To evaluate racial disparities in the diagnosis and treatment of penile cancer among a contemporary series of men from a large diverse national data base.
  
  
  METHODS
  Using the 1998-2012 National Cancer Data Base, all men with squamous cell carcinoma (SCC) were stratified by race and ethnicity. Demographic and disease characteristics were compared between groups. Likelihood of undergoing surgery and type of surgery were compared among patients with nonmetastatic disease. Factors influencing disease stage and treatment type were analyzed with univariate and multivariable logistic regressions. Overall survival was examined with Kaplan-Meier and adjusted Cox proportional hazard models.
  
  
  RESULTS
  We identified 12,090 men with penile SCC with median age 66 years (range 18-90). Distribution of patients is as follows: 76.8% Caucasian, 10.2% African American (AA), 8.7% Hispanic. On multivariable analysis, Hispanic men are more likely to present with high-risk (≥T1G3) penile SCC (odds ratio [OR] 1.6; confidence interval [CI] 1.20-2.00; P = .001) and tend to undergo penectomy rather than penile-sparing surgery (OR 1.46; CI 1.15-1.85; P = .002) for equal stage SCC compared to Caucasian patients. Whereas AA men are less likely to undergo surgery of any type (OR 0.67; CI 0.51-0.87; P = .003) and have higher mortality rates than Caucasian patients (hazard ratio 1.25; CI 1.10-1.42; P < .001).
  
  
  CONCLUSIONS
  Hispanic men with penile SCC are more likely to present with high-risk disease and undergo more aggressive treatment than Caucasian patients but have comparable survival. AA men are less likely to undergo surgical management of their disease and have higher mortality rates.
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: Emily.slopnick@uhhospitals.org.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Slopnick
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kiechle
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Gonzalez
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D010412:Penile Neoplasms / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy*; D014481:United States; D044465:White People; D055815:Young Adult