Penile cancer is on the rise, and here are the sexual practices that contribute to it.

Often misunderstood, taboo, yet on the rise: penile cancer is increasing, driven by sexually transmitted infections and a lack of preventative measures. This is paradoxical, given that when detected early, it is curable in the vast majority of cases.

Atlantico: What factors explain the 20% increase in cases of penile cancer in the United Kingdom, and is there a similar trend in France, where HPV vaccination for boys is now mandatory?

Didier Legeais: The leading cause of penile cancer is sexually transmitted infections. Next come hygiene problems. Another reason for the increase in penile cancer is the aging population.

It's important to distinguish between the increase in penile cancer among young people, which is linked to STIs, particularly the human papillomavirus (HPV), which causes genital warts. This is the leading cause. By increasing vaccination rates, we protect women, but also men. In men, the link is strong because genital warts are quickly visible. In women, they are invisible, located on the cervix, and can develop for years before being detected.

Hence the importance of screening. Vaccination will reduce these cases.

The other factor is the increase in the population over 75: it has risen from 6 million to 12 million and is expected to reach 20 million. This creates a second problem: advanced penile cancer in men with phimosis. The narrowing of the skin means that cancer can develop under the skin without being seen. When these men seek medical attention, they are often faced with invasive cancers that sometimes require partial or total amputation.

The 20% increase makes sense: penile cancer is very rare. So a percentage increase seems enormous, but in terms of the number of cases, it remains small.

Why does the awareness rate of penile cancer remain so low (10% of men in France and the United Kingdom)? How can prevention be improved?

Prevention is about repeating information. If you inform a generation in 2000, you have to do it again in 2005, then in 2010, and so on. The information must be constantly renewed.

Penile cancer is very rare. For a long time, this was therefore not widely publicized. It's already difficult to inform men over 50 about prostate cancer screening, even though prostate cancer kills a man every few minutes. It's also difficult to inform young men about testicular cancer, even though self-examination can save lives.

Penile cancer is even less common. Prevention could be improved by reminding men of the importance of examining their testicles, penis, and foreskin to check for cancer.

This information needs to be repeated in 5, 10, 15, and 20 years. National campaigns, like those for breast or colon cancer, are necessary to remind younger generations about age-related diseases. Prevention must be passed down from generation to generation.

What are the differences between British (9 specialist centers, conservative surgery) and French (screening, HPV vaccination) strategies for reducing mortality, and what good practices could be shared?

The strategy is based on two pillars: vaccination and self-testing.

France was held back by the anti-vaccine movement. Australia set an example in the fight against cervical cancer. It was necessary to communicate effectively to convince people that vaccination protects young women. Every year, young women aged 25 or 26 died from cervical cancer linked to the human papillomavirus (HPV).

In France, two vaccines were used, then Gardasil became the preferred option because it covers more variants. For men, it's important to convince people that the vaccine is beneficial. It's often thought that men are vaccinated to protect women, but they are also protecting themselves against penile cancer.

The Covid crisis has reinforced distrust. We must convince people that this vaccine, like others, is essential to saving lives.

Surgery for penile cancer is straightforward if performed early. It becomes very complex if the diagnosis is delayed, particularly in cases of lymph node involvement. Urologists have therefore organized themselves to create expert centers for complex surgeries.

How can we encourage men to seek medical help earlier when faced with symptoms that are often minimized due to shame or lack of awareness, given that the survival rate exceeds 90% if cancer is detected early?

This is a matter of national education. The increase in penile cancer among older men shows that they are seeking medical help late. Therefore, younger men need to be educated about testicular self-examination and self-examination of the penis with the foreskin retracted.

We also need to support campaigns targeting mothers and young people, explaining that if it's detected early, there's no problem: sometimes minor surgery is all that's needed. If it's detected late, amputation of the penis may be necessary.

In advanced cases, the glans may disappear and be replaced by a cauliflower-like mass. These are very serious situations, avoidable through early detection.