A noteworthy global multinational study of HPV and cervical cancer . Association between male circumcision and women's biomedical health. Does male circumcision reduce the risk of cervical cancer in their female correlation between circumcision and incidence of cervical cancer. Circumcised men should be as vigilant in preventing oncogenic HPV annual meeting of the American Urological Association were twice as likely or adjust any potential associations between HPV and circumcision by age.
Electronic supplementary material The online version of this article doi: Penile neoplasms, Male circumcision, Phimosis, Papillomavirus infections Introduction Penile cancer is relatively rare globally with an annual incidence of less than 1 case perperson-years pyr in Western countries [ 1 ]. However, recorded incidences are higher in many countries in sub-Saharan Africa including Uganda 2.
Similarly, although penile cancer accounts for less than 0. Other factors associated with increased risk of penile cancer include low socio-economic status, cigarette smoking, human papillomavirus HPV infection, lack of penile hygiene, phimosis and penile inflammation [ 8 ].
Can Penile Cancer Be Prevented?
Subsequent case series also showed a lower than expected prevalence of neonatal circumcision among penile cancer cases [ 10 — 12 ]. Ecological evidence came from studies in East Africa in the s which showed that penile cancer was more common than expected in traditionally non-circumcising ethnic groups than among traditionally circumcising ethnic groups [ 613 ].
The first case—control study of penile cancer, published in among American military personnel, showed that circumcision in childhood was rare among cases of penile cancer compared to controls 1. Although male circumcision is widely cited to protect against penile cancer [ 15 — 19 ], the epidemiological evidence has never been systematically evaluated.
Circumcision services are currently being expanded for HIV prevention in several African countries [ 20 ], and as penile cancer incidence is relatively high in many of these countries, expansion of circumcision services may provide an opportunity to reduce incidence of penile cancer.
Penile Cancer, Cervical Cancer and Circumcision Status
The aim of this paper is to systematically review and summarise the epidemiological evidence of an association between male circumcision and penile intraepithelial neoplasia PINin situ and invasive penile cancer, and to discuss the possible mechanisms and biological pathways for the association.
No language restrictions were imposed. We did not include circumcision in the search terms to avoid detection bias.
We also searched reference lists of relevant papers. Where information was missing from published papers, we contacted authors to obtain relevant information.
Epidemiological studies likely to contain information on risk factors for penile cancer were deemed potentially relevant. Agreement about potential relevance was reached by consensus, and full text copies of those papers were obtained. Outcome definition Penile cancer included penile intra-epithelial neoplasia PINin situ and invasive penile cancer. As in situ and invasive penile cancer may develop along different pathways [ 2122 ], and several studies have indicated that the effect of circumcision may vary depending on the stage of penile cancer [ 23 — 25 ], we decided a priori to analyse the effect of circumcision on 1 high-grade PIN and in situ penile cancer and 2 invasive penile cancer separately.
Data extraction Data were extracted independently by two authors NL and HW using a standardised pre-piloted data extraction form. Inconsistencies were discussed by both reviewers and consensus reached. Study populations described in more than one paper were included only once, using data from the paper with most information on the study methods.
Methodological quality of included studies Seven quality domains were identified for case—control studies and six for cross-sectional studies see supplementary material.
We adopted an approach similar to that used by the Cochrane Collaboration for assessing risk of bias in randomised studies [ 26 ] and studies were classified as having either a high, low, or an unclear where data were not reported risk of bias for each quality domain.
A thousand infants would be mutilated, and several would die to prevent that one case of cancer.
Who could scientifically advocate foreskin amputation for this reason? In its Statementthe Canadian Paediatric Society noted: Cadman, Gafni and McNamee To reduce the risk of penile cancer, men are best advised simply to use reasonable hygiene, practice responsible sexual behavior, and to avoid handling tobacco. The history of the penile cancer myth was published by Fleiss and Hodges in the British Medical Journal Post-circumcision cancer may occur at the circumcision scar.
One may hypothesize that the circumcision scar tissue is less resistant to penetration of HPV which then transfers DNA to the human cell and starting the growth of the neoplasm.
Can Penile Cancer Be Prevented?
More research is needed to determine the etiology of post-circumcision cancer. The American Cancer Society issued a five part advisory statement on penile cancer in June Circumcision is not considered to be beneficial in preventing or reducing the risk of penile cancer.
Sexually active adult males with a non-retractable foreskin should have the phimotic condition treated. See phimosis for conservative treatment options.
Circumcision is outmoded as a treatment for phimosis. The cancer only occurs in 1 inmen. Penile cancer usually occurs well beyond age 50, although it can occur earlier. A newly developed human papillomavirus HPV bi-valent vaccine is expected to offer protection against all forms of ano-genital cancer, including penile cancer, when it becomes available.
Even if it did, it would no longer be necessary due to the expected availability of a HPV vaccine.
Cervical cancer in partners The hypothesis that cervical cancer is caused by smegma of the male foreskin was invented in by Wynder. His study was found to be invalid, because most of the cervical cancer patients in his study incorrectly reported that their husbands were uncircumcised. These women had no idea whether their husbands were circumcised or not.
They gave the answer they thought the doctor wanted to hear. Wynder later recognized and admitted the error in An almost ideal population was that of the well women attending a cancer detection facility, where the population was split almost equally between women whose husbands were circumcised and those whose husbands were not.
The discovery rate for cancer of the cervix among non-Jewish women whose marital partners were circumcised was no different from the rate among non-Jewish women with noncircumcised husbands.
Male circumcision and penile cancer: a systematic review and meta-analysis
Further, the use of a sheath contraceptive by the marital partner, which has an effect equivalent to circumcision in that the cervix is protected from contact with the smegma, was found not to be associated with rate differences for cancer of the cervix. HPV infection is a necessary condition for cervical cancer. That article purported to show that circumcision reduced the risk of infection to the wives of circumcised men.
This article has experienced severe and unrelenting criticism due to numerous methodological flaws, its conflict with other published research, and other research by the same authors that showed that different types of HPV were found in husbands and wives.
- Penile cancer, cervical cancer, and circumcision
The publication of this flawed article may have been the result of those editorial problems. Infection with human papillomavirus HPV is a necessary condition for the formation of cervical cancer. Abraham Wolbarst's promotional claims that circumcision prevented penile cancer were false and mislead the medical community for decades.