Low education level and low disposable income are among the socioeconomic factors that place men at risk for invasive penile cancer, a new study found.

Men who are divorced or never married or who live in a single-person household also are at higher risk.

The findings, from a large population-based of 11,548 Swedish men, possibly reflect social differences in lifestyle, health awareness, and health-seeking patterns, according to a paper published online in BJU International by Christian Torbrand, MD, of Skåne University Hospital in Malmö, and colleagues.

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The study population included 1676 men diagnosed with penile cancer from 2000 to 2012 and 9872 randomly selected controls. Compared with men who had a high education level (13 or more years of schooling), men with a low level (9 or fewer years of schooling) had 25% increased odds of invasive (T1–T4) penile cancer in adjusted analyses. Men with a low disposable income level (lowest 50% income among the controls) had 23% increased odds of T1–T4 penile cancer compared with men who had a high income level (highest 50% income among the controls).

Compared with married men, divorced men and men who never married had 42% and 46% increased odds of penile cancer, respectively, 69% and 67% increased odds of in situ disease (Tis), and 34% and 39% increased odds of T1–T4 disease.

Results also showed that men in multiple-person households had a lower risk for penile cancer overall and for Tis and T1–T4 disease than those in a single-person household. For example, men in a household of 3 or more people had 24%, 43%, and 12% decreased odds of any penile cancer, Tis disease, and T1–T4 disease, respectively, versus those in a single-person household.

Among the 928 men with invasive penile cancer, the 1- and 3-year cancer-specific mortality rates were lower in men with a high education level and high disposable income as well as those who were married and living in household with 2 or more individuals, but these associations did not reach statistical significant after adjusting for age TNM stage, and comorbidities, the researchers reported.

“Our present findings provide evidence of socioeconomic gradients, not only in the risk of developing penile cancer, but also regarding primary tumour stage at presentation,” the investigators wrote.

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Dr Torbrand and colleagues noted that the population-based design and large number of patients were strengths of the study. “By means of record linkage, individual level data on socioeconomic factors, concomitant disease and vital status, were retrieved from high-quality population-based registries.”

Regarding study limitations, the researchers acknowledged that no data were available on smoking history, an established risk factor for penile cancer. They noted, however, that they used a history of previous hospitalization with a diagnosis of chronic obstructive pulmonary disease as a proxy for smoking.