Presentation Authors: Daniela Kaefer*, Paul Sutcliffe, Shaelyn Cavanaugh, Joseph Jacob, Elizabeth Ferry, Syracuse, NY
Introduction: While penile cancer is a rare disease in the United States, survival rates are strongly related to stage at diagnosis. Understanding the stage-incidence of this disease is central in understanding its impact on the US population. This study aims to assess the stage-incidence of penile cancer both before (2004-2009) and after (2014-2015) implementation of Medicaid insurance expansion through the Affordable Care Act (ACA), as well as the risk factors for penile cancer by stage at diagnosis.
Methods: The National Cancer Data Base (NCDB) was queried and patients with penile cancer from 2004-9 and 2014-15 were categorized by low (0-I) or high stage (II-IV). Disease incidence rates during the pre- and post-expansion years were calculated and multivariate analysis was used to assess odds ratios for these categories. Risk factor covariance was then assessed through chi-square analyses. Variables with a p-value < 0.01 were considered statistically significant.
Results: Of the 6769 men with penile cancer included in our study, 40.1% were found to have had higher stage disease. Patients diagnosed with higher stage disease were more likely to be uninsured, be black, be of Hispanic ethnicity, and be older than low stage patients. Lower stage patients were more likely to live in areas with higher educational attainment and higher median income. After adjusting for age, payer, race, ethnicity, population income, population education, and Charlson/Deyo score, patients diagnosed after the Medicaid expansion showed a statistically significant elevated risk of higher stage disease (OR=1.445 95%CI (1.229-1.608) p < 0.001) compared to patients diagnosed in 2004-2009.
Conclusions: There was a significant increase in higher stage penile cancer cases diagnosed after Medicaid expansion, and minority groups were represented in greater proportions in the higher stage group. Further studies are needed to understand the underlying causes and whether these findings will persist as insurance access improves.