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Male Circumcision, Penile Human Papillomavirus Infection, and
Cervical Cancer in Female Partners
Methods
Results
Conclusions
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Newspaper Articles and Editorials.
Circumcision and genital dermatoses
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.
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
"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.
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.
Links to further Medical Research Papers (some off-site)
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.
Mallon E, Hawkins D, Dinneen M, Francics N, Fearfield L, Newson R,
Bunker C
Arch Dermatol 2000 Mar;136(3):350-4
PMID: 10724196, UI: 20186791
Dahn R, Selzer HL, Lapides J, J Urol 1973; 110: 79-80
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."
