The Link between Circumcision and Penile Cancer

Summary of Research Results

(To be added)

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Medical Articles and Abstracts

Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners
Xavier Castellsagué, M.D., F. Xavier Bosch, M.D., Nubia Muñoz, M.D., Chris J.L.M. Meijer, Ph.D., Keerti V. Shah, Dr.P.H., Silvia de Sanjosé, M.D., José Eluf-Neto, M.D., Corazon A. Ngelangel, M.D., Saibua Chichareon, M.D., Jennifer S. Smith, Ph.D., Rolando Herrero, M.D., Victor Moreno, M.D., Silvia Franceschi, M.D., for the International Agency for Research on Cancer Multicenter Cervical Cancer Study Group
New England Journal of Medicine April 2002; 346: 1105

We pooled data on 1913 couples enrolled in one of seven case–control studies of cervical carcinoma in situ and cervical cancer in five countries. Circumcision status was self-reported, and the accuracy of the data was confirmed by physical examination at three study sites. The presence or absence of penile HPV DNA was assessed by a polymerase-chain-reaction assay in 1520 men and yielded a valid result in the case of 1139 men (74.9 percent).

Penile HPV was detected in 166 of the 847 uncircumcised men (19.6 percent) and in 16 of the 292 circumcised men (5.5 percent). After adjustment for age at first intercourse, lifetime number of sexual partners, and other potential confounders, circumcised men were less likely than uncircumcised men to have HPV infection (odds ratio, 0.37; 95 percent confidence interval, 0.16 to 0.85). Monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than women whose partners were uncircumcised (adjusted odds ratio, 0.42; 95 percent confidence interval, 0.23 to 0.79). Results were similar in the subgroup of men in whom circumcision was confirmed by medical examination.

Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners.

For press releases regarding this article, see the Section Newspaper Articles and Editorials.

Circumcision and genital dermatoses
Mallon E, Hawkins D, Dinneen M, Francics N, Fearfield L, Newson R, Bunker C
Arch Dermatol 2000 Mar;136(3):350-4

CONTEXT: It is well recognized that the presence of a foreskin predisposes to penile carcinoma and sexually transmitted infections. We have investigated the relationship between the presence or absence of the foreskin and penile dermatoses. OBJECTIVE: To determine whether there is an association between circumcision and penile dermatoses. DESIGN: A retrospective case control study of patients attending the department of dermatology with genital skin conditions. SUBJECTS: The study population consisted of 357 male patients referred for diagnosis and management of genital skin disease. The control population consisted of 305 male patients without genital skin disease attending the general dermatology clinics over a 4-month period. MAIN OUTCOME MEASURES: The relationship between circumcision and the presence or absence of skin disease involving the penis was investigated. The rate of circumcision in the general male dermatology population was determined. RESULTS: The most common diagnoses were psoriasis (n = 94), penile infections (n = 58), lichen sclerosus (n = 52), lichen planus (n = 39), seborrheic dermatitis (n = 29), and Zoon balanitis (n = 27). Less common diagnoses included squamous cell carcinoma (n = 4), bowenoid papulosis (n = 3), and Bowen disease (n = 3). The age-adjusted odds ratio for all penile skin diseases associated with presence of the foreskin was 3.24 (95% confidence interval, 2.26-4.64). All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichen planus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised. CONCLUSIONS: Most cases of inflammatory dermatoses were diagnosed in uncircumcised men, suggesting that circumcision protects against inflammatory dermatoses. The presence of the foreskin may promote inflammation by a koebnerization phenomenon, or the presence of infectious agents, as yet unidentified, may induce inflammation. The data suggest that circumcision prevents or protects against common infective penile dermatoses.

PMID: 10724196, UI: 20186791

The Relationship Between Circumcision And Cancer Of The Penis, Edgar J.Schoen, MD, Journal Of The American Cancer Society, September/October 1991, Vol.41, No.5; 306-309

"Undocumented policy statement, heated arguments, media interest, and trendy lay anticircumcsion groups have generated much heat and have confused issues that seemed clear prior to 1970."

"In a classic 1935 report and discussion Dean analyzed 120 cases of penile cancer from Memorial hospital in New York City. None were Jews, although more than one third of the cancer patients at the hospital were Jewish. Dean noted that circumcision later in life did not offer the complete protection against penile cancer that newborn circumcision did. In Dean's series, the average age of diagnosis of cancer of the penis was 50, with 22 percent before age 40.

"In the subsequent 56 years, published studies from other US medical centers have confirmed Dean's findings. There were reports of 139 penile cancers from Illinois in 1946; 100 from Rosewell Park, New York, in 1972; 156 cases from Michigan in 1973; and 77 from Cleveland in 1986. Of the resulting 592 penile cancer cases from five institutions around the US, not one of the men had been circumcised in infancy despite the fact that by the mid 1970's most males in the US had been circumcised as newborns."

Carcinoma of the penis and the anti-circumcision crusade
Dahn R, Selzer HL, Lapides J, J Urol 1973; 110: 79-80

"During 25 years at the University of Michigan medical Center, we have been impressed by the mortality associated with carcinoma of the penis and the relationship of the prepuce to the disease." A high percentage of patients do not seek medical treatment until the disease is in an incurable state. "Our evidence leads us to believe that circumcision-- at any age will virtually prevent onset of squamous cell carcinoma of the penis if the neoplasm is not present at the time of circumcision and the prepuce is completely removed."

Cambells Urology, Vol2, 5th Ed, 1986, p. 1590

"Any argument against circumcision must take into account that the fact that penile carcinoma represents the only neoplasm for which there exists a predictable and simple means of prophylaxis that spares the organ at risk"

Urology Times, March 1987, p 11

Dr. Terrence Malloy noting the effectiveness of treating preinvasive carcinoma of the penis with a laser states further, "It avoids the disabling sexual and psychological trauma associated with partial penectomy." He concludes that although penile cancer has usually been restricted to the elderly in the United States, "in the future urologists will be seeing more penile cancer due to the reduction in routine circumcision."

Erythroplasia of Queyrat Graham JH, Helwig EG Cancer 1973: 32; 1396-1414

Observations from 100 men with Erythroplasia of Queyrat (EQ is a precancerous condition) indicate that the disease is a distinct entity of men only. Some observers believe that EQ is Bowens disease of the penile mucosa with carcinomatous potential (10 patients had invasive squamous cell carcinoma (SCC). The lesions involved mucosal sites on the distal part of the penis including the glans, urethral meatus, frenulum, corona, sulcus and prepuce.
A common occurance was difficulty in retracting the foreskin over the glans. The one consistent genital feature was that 84 patients had not been circumcised before the onset of their penile lesions. The age at time of circumcision was 9 years, 18 years, and adulthood in three others. Status of circumcision in 13 patients was not known. The definate etiology of EQ remains unknown, but factors in cancer developement may be local carcinogens in uncircumcised men. "There is only one certain aspect regarding the cause of EQ and that is the disease is similar to SCC of the penis in occuring in non-Jewish uncircumcised peoples of the world."

Malignant melanoma of the penis and male urethra Oldbaing J, Mikulowski P Cancer 1987: 59; 581-587

The authors citing date from the Swedish Cancer Registry reported 1210 cases of carcinoma of the penis from 1958 to 1980. [Thus the average rate in Sweden is 55 cases/year versus the United States average of 748 cases/year. Since the Swedish population (Information Please Almanac, 1985) is 8.330 million versus a U.S.A. of 233.70 million, the U.S.A. is 28.05 times greater in population. Therefore, a rate of 55x28.05=1543 penile cancer cases might be expected in the United States whereas onlt 748 were seen. this 2 times graeter rate of penile cancer in Sweden where newborn circumcision is not practiced undercuts statement by anti-circumcision activists who continually use the Nordic societies as samples of good hygiene thereby able to prevent cancer of the penis equally as well without circumcision.-AJF, Circumcision: A Parent's Decision for Life]

Penile Cancer: Is there an epidemiological role for smoking and sexual behavior? Hellberg D, Valentin J, Eklund T, Nilsson S Brit Med J 1987: 295; 1306-1308

"In Sweden an average of 50 men a year are diagnosed as having cancer of the penis giving an incidence of 1.4 per 100,000. All cases of cancer are registered at the National Cancer registry which in 1959-80 registered 1064 new cases."

Circumcision and penile carcinoma Leiter E, Lefkovits A NY St J Med August 1975: 1520-1522 "Circumcision at birth virtually prevents the later development of penile cancer."

Penile carcinoma in circumcised males Boczko S, Freed S NY St J Med November 1979: 1903-1904

Incidence is so rare that only nine cases have been reported in the world literature to date.

Circumcision and the risk of cancer of the penis Hosze K, Mcurdy S Am J Dis Child 1980: 134; 484-486

"The lifetime risk for cancer of the penis in uncircumcised males is one in 600.

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Links to further Medical Research Papers (some off-site)

  1. Keneth A Arndt An Ulcerative Lesion of the penis. Diagnosis: Squamous cell carcinoma of the penis Archives Of Dermatology October 1997

  2. Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL, Daling JR History of circumcision, medical conditions, and sexual activity and risk of penile cancer J Natl Cancer Inst 1993: 85(1); 19-24

  3. Agarwal SS, Sehgal A, Sardana S, Kumar A, Luthra UK Role Of Male Behavior In Cervical Carcinogenesis Among Women With One Lifetime Sexual Partner Cancer 1993: 72(5); 1666-1669

  4. Kjaer SK, de Villiers EM, Dahl C, Engholm G, Bock JE, Vestergaard BF, Lynge E, Jensen OM Case-control study of risk factors for cervical neoplasia in Denmark. I: Role of the "male factor" in women with one lifetime sexual partner Int J Cancer 1991: 48(1); 39-44

  5. Gajalakshmi CK, Shanta V Association Between Cervical And Penile Cancers In Madras, India Acta Oncol 1993: 32(6); 617-620

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