Trends in incidence, mortality and treatment of penile cancer before and after centralisation of penile cancer services in England (1990–2009)

Abstract

Objective: Penile cancer services were centralised in England in 2002. Has this had an impact on treatments for penile cancer and survival? Patients and methods: All cases of penile cancer from 1990 to 2009 were identified from national cancer registry data. Mortality data were obtained from the Office for National Statistics and survival data were extracted from a national population-based database, the Cancer Information System. Socioeconomic deprivation was calculated using a national income deprivation score and surgical treatments were obtained from Hospital Episode Statistics (HES) data. Results: The number of penile cancer cases recorded rose from 300 to 400 per year during the early period of centralisation. There was a significant rise in the age-standardised incidence of penile cancer from 1.2 per 100,000 to 1.4 per 100,000 during this period. Mortality remained stable at 0.3 per 100,000. One-year and five-year relative survival remained stable after centralisation at 88% and 72% respectively. The incidence and mortality of penile cancer was significantly higher in the most deprived quintile of the population. Following centralisation, the number of total penile amputations was low at 11% but only 39% of men were recorded as having lymph node surgery, although this may reflect poor compliance with coding rather than true practice. Conclusions: The incidence of penile cancer in England is rising, but mortality and survival remains stable. Incidence and mortality is higher in more deprived areas, and greater public awareness of this disease and its risk factors are needed. By 2009, rates of penile amputation were low but potentially the proportion of lymph-node surgery remained low. This may change with the uptake of inguinal sentinel lymph-node sampling.

Update on penile sparing surgery for penile cancer

“…A similar study within the United Kingdom showed a significant increase in the amount of PSS and decrease in mortality following centralisation of care in a retrospective analysis [18]. A cancer registry database study in England post centralisation found a low rate of total penile amputations [19]. In the United States, a study using the National Cancer Data Base found that there was evidence of ‘informal centralisation’ occurring within Academic Centres which were treating higher-stage cancers and were treating a larger volume of patients [20].…”