Referrals into a dedicated British penile cancer centre and sources of possible delay

To assess sources of delay in referral to a specialist Urology clinic for penile cancer.

Patients with penile cancer seen during the period December 2002 to December 2007 were identified from the unit's database. Information regarding presentation, diagnosis and pattern of referral was retrieved from records. Delay was defined as the time between the patient first noticing a penile lesion and date of first seeking medical advice, or additional time before being seen by a Urologist resulting from referral to another specialty.

Of 100 patients, with a median age of 54 years (range 2-81 years), 19% were initially referred to other specialties (Genitourinary Medicine-13%, Dermatology-4%, Plastics 2%). Initial referrals to Genito-urinary Medicine and Dermatology resulted in mean delays of 6 and 3.5 months respectively, whereas the mean duration for patients to present to any medical practitioner from onset of symptoms was 5.8 months. Overall, 47% presented with locally advanced disease.

Approximately one-fifth of patients with penile cancer are first referred to specialties other than Urology. This sometimes delays diagnosis, potentially affecting overall prognosis. The major source of delay, however, results from patient reluctance to seek medical advice. Thus, the greatest impact in this condition is likely to be achieved by increased public awareness and education.