Open Access

ARTICLE

Demographic disparities of penile cancer in Appalachian Kentucky

Patrick J. Hensley, John Loomis, Jason R. Bylund, Andrew C. James

Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
Address correspondence to Dr. Andrew C. James, Department of Urology, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536 USA

Canadian Journal of Urology 2021, 28(3), 10713-10718.

Abstract

Introduction: Appalachian Kentucky is a region characterized by poor healthcare literacy and access. We investigate the disparities in demographic distribution and outcomes of penile squamous cell carcinoma (pSCC) in rural Kentucky.
Materials and methods: Data were retrieved for patients with pSCC from 1995-2015 from the Kentucky Cancer Registry and the Surveillance, Epidemiology and End Results Program (SEER) and were used to investigate differences between Appalachian Kentucky and the remainder of the state and country.
Results: The incidence of pSCC from 1995-2015 in Appalachian Kentucky was over 60% higher than in non-Appalachian regions (2.6 vs. 1.6 cases/100,000 people). Nearly 40% of cases were from Appalachian counties. Patients presented with similar grade and pT stage at diagnosis but were more likely to have pN+ disease (p < 0.001). Rates of cancer-specific mortality (CSM) were similar between the two regions, but patients with CSM exhibited shorter survival intervals from diagnosis in Appalachia (median 20 vs. 26 months, p = 0.016). Compared to national SEER data, patients from Appalachian Kentucky presented with similar grade and stage but exhibited higher rates of CSM (24.0% vs. 20.1%, p = 0.029). African Americans (AA) comprised only 5% of patients but exhibited high pathologic stage at presentation (p = 0.041) and shorter survival intervals (median 12 vs. 23 months, p = 0.023) compared to Caucasians.
Conclusions: There is a disproportionately high rate of pSCC in Appalachian Kentucky. Both Appalachian and AA men exhibited more advanced disease at presentation and shorter survival, identifying socioeconomic and racial disparities which can be targeted to improve outcomes in high-risk individuals.

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