PERFIL EPIDEMIOLÓGICO E PADRÕES ESPACIAIS DO CÂNCER DE PÊNIS NO MARANHÃO: Análise de incidência, mortalidade e implicações para Políticas Públicas de Saúde

Abstract

Penile cancer (CaPe) is a rare neoplasm in high-income countries; however, it remains an important public health problem in regions marked by socioeconomic vulnerabilities and limited access to healthcare services. It is estimated that approximately 100,000 men are affected globally, and in Brazil, although it represents about 2% of male cancers, it shows a profoundly unequal distribution, with a significant concentration in the Northeast Region. In this context, the state of Maranhão stands out for presenting the highest penile cancer incidence rates ever described worldwide, constituting a unique and alarming scenario. Objective: To analyze, in an integrated manner, the epidemiological profile, mortality, and spatial distribution of penile cancer cases in the state of Maranhão, identifying territorial risk patterns and priority areas for public health intervention. Methods: Cross-sectional, quantitative, population-based study, complemented by ecological analysis at the municipal level. The study population included men aged 18 years or older diagnosed with penile cancer between 2013 and 2022, with data obtained from reference hospitals and the Mortality Information System (SIM). A total of 518 patients were analyzed, of whom 261 progressed to death. Descriptive analyses and spatial analysis were performed using the Global and Local Moran’s Index (LISA), local empirical Bayesian estimates, and Kernel density, allowing identification of spatial autocorrelation patterns, concentration areas, and territorial inequalities in incidence and mortality rates. Results: Maranhão presented a standardized incidence rate of 18.83 cases per 100,000 men, making it the state with the highest disease burden in the country. The mortality rate was the highest in the Northeast region, reaching 8.03 deaths per 100,000 men. Most patients were 60 years or older (59.1%), of mixed race (36.3%), rural workers (45.8%), and had low educational attainment, including 25.6% who were illiterate. Squamous cell carcinoma was the most frequent histological type (60.7%), with a predominance of tumors in the early stage (T1: 23.4%), although mutilating procedures, such as partial penectomy, were widely used (49.6%). Spatial analysis revealed high-incidence clusters concentrated in the northern and southwestern regions of the state, while the eastern and southern areas showed lower rates. Dissociation between incidence and mortality was observed in some territories, suggesting inequalities in access to timely diagnosis and specialized treatment.Conclusions: Penile cancer in Maranhão presents a highly heterogeneous spatial distribution, strongly associated with contexts of social vulnerability, rurality, and weaknesses in the healthcare network. Integration of clinical, epidemiological, mortality, and spatial data highlighted critical territories that demand immediate actions in surveillance, prevention, early diagnosis, and strengthening of specialized care. These findings provide strategic support for territorialized planning of public policies aimed at men’s health and addressing health inequalities in the state.