Circumcision and Cancer
Cancer is a terrifying malady, and the threat of it has been a powerful motivation for circumcising babies, reaching its nadir in David Reuben's compendium of misinformation, Everything You Ever Wanted To Know About Sex... with its "... and the remedy for penile cancer is CASTRATION. And THAT is THAT."
Who would not circumcise to prevent castration? The reality is more ambiguous.
Penile cancer is one of the rarest cancers - rarer even than breast cancer in men - and figures for it are hard to come by. Circumcised men get penile cancer at about the same tiny rate as intact men. Studies that seemed to show a correlation had not been corrected for age; penile cancer is a disease of old men, and the old men with cancer in the studies had simply been born at a time when circumcision was less customary than when the younger men without cancer were born. When men of the same ages were compared, the correlation vanished.
This graph illustrates both the rarity of penile cancer and its lack of connection with circumcision:
(If you do not see the graph at full size, click here.)
It would be erroneous to conclude from this that circumcision tends to cause penile cancer. Other factors, such as different prevalence of smoking in the two countries, may account for the difference.
The American Cancer Society's website includes this information:
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Circumcision: Whether or not circumcision is a negative risk factor (if it protects against penile cancer) is a very controversial issue. (Phimosis can be treated without surgery.) |
The American Cancer Society's "Cancer Facts and Figures-1996" gave these figures for the incidence of different cancers:
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The leading sites of cancer in males are: prostate, with 317,100 cases; lung, 98,900; colon and rectum, 67,600; bladder, 38,300; lymphoma, 33,900; melanoma, 21,100; oral, 20,100; kidney, 18,500; leukemia, 15,300; stomach, 14,000; pancreas, 12,400; and liver, 10,800. Having listed prostate and testis separately, it listed "other and unspecified reproductive". The projected number of cases of "other and unspecified reproductive, male" cancers for 1996 was 1,200. Even if we assume that these are all penile cancer cases - not all of which would be sited on or near the foreskin - that is a tiny fraction of all cancers. With a total of 649,100 cases of cancer in males, "other and unspecificed reproductive" cancers in males amounted to 0.18% of malignancies. The leading sites of cancers causing death are: lung, 94,400; prostate, 41,400; colon and rectum, 27,400; pancreas, 13,600; lymphoma, 13,600; leukemia, 11,600; esophagus, 8,500; liver, 8,400; stomach, 8,300; bladder, 7,800; kidney, 7,300; and brain, 7,200. Projected deaths from "other and unspecified reproductive" cancers in males were 220. That's 0.093% of the total cancer deaths. Some of the rare cancers, other than "other and unspecified reproductive, male" that men are more likely to get and perhaps die from, include: lip, tongue, mouth, pharynx, oesophagus, small intestine, larynx, bone, connective tissue, Hodgkin's disease, testis, and thyroid. Male breast cancer amounted to 1,400 cases, with 260 deaths, so American men are more likely to suffer and die of breast cancer than penile cancer - yet no-one suggests neonatal amputation of a male's useless breasts to protect him against this malignancy. 1999
Figures from the American Cancer Society. |
Could circumcision cause penile cancer?
J Urol. 2006 Feb;175(2):557-61; discussion 561. Related Articles, Links Outcome of penile cancer in circumcised men.
PURPOSE: We previously reported on a group of patients with post-circumcision carcinoma of the penis. We now study the long-term outcome of these patients. MATERIALS AND METHODS: We retrospectively reviewed the available charts of 22 patients presenting between October 1979 and May 2000. RESULTS: Of 22 patients 18 underwent ritual circumcision with extensive scar development. Median age at diagnosis was 62.4 years. The penile lesion was dorsal and proximally located in 15 patients. Median delay before diagnosis was 12 months. Clinically 14 patients had stage T1-T2 disease, with 13 having no lymph node involvement and none with distant metastasis, 8 patients had stage T3-T4 disease. A total of 15 patients were treated surgically with total penectomy (10) or conservative local excision (5), inguinal lymph node dissection (9) and subsequent penile reconstruction (3). Pathological staging in 15 patients revealed 10 patients with stage T1 and in 8 patients with lymph node dissection none had nodal metastasis. Histopathological classification was 20 squamous cell carcinoma, 1 sarcoma and 1 verrucous carcinoma. Six patients refused surgery and 1 was referred for palliation. Median followup was 14.5 months and median survival was 14.5 months. The 3-year survival was 42% for stage T1-T2 and 13% for T3-T4 (p = 0.0052). Median survival for the surgical group was 34 months whereas for nonsurgical group was 3 months (p = 0.0016). Recurrence-free survival in the surgical group was 50%. CONCLUSIONS: Penile carcinoma in circumcised men is a distinct disease commonly following nonclassic vigorous circumcision. Delayed diagnosis and deferring surgical treatment are associated with increased mortality. PMID: 16406995 [PubMed - in process] |
In 1954, Ernest Wynder suggested that intact men's smegma caused cervical cancer in their partners. He later found that the women he'd asked had no idea whether their husbands were circumcised or not. Other studies were based on correlations: a population of Jewish women was compared with a population of gentile women. When gentile women with circumcised husbands were compared to gentile women with intact husbands, the correlation vanished.
1. Cancer of the Cervix in Reference to Circumcision and Marital History
Elizabeth Stern, M.D., Peter Neely, Ph.D.
Journal of the American Medical Women's Association
Vol. 17, No. 9 (Sept. 1962)
"Since the recommendation had been made that circumcision should be used as a preventative measure against cancer of the cervix, we sought further confirmation of this hypothesis. 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. 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."
2. ------
Journal of the American Medical Association, June 2, 1975, p. 961,
Ernst L. Wynder, M.D., American Health Foundation.
"Additional variables observed to be more frequent and of more import among patients with cervical cancer are early age of first intercourse, multiple sexual parners, and low socioeconomic class. Unless there exist surgical reasons (such as phimosis) indicating circumcision in the husband, the procedure would seem unwarranted."
3. Relation of cirumcision to cancer of the cervix
Am. J. Obstet. Gynecol., Dec. 15, 1973
Terris, Wilson, Nelson.
"No differences were found in circumcision status of husbands of cervical dysplasia patients and controls. The findings of this study are consistant with those reported by Aitken-Swan and Baird. They fail to provide evidence that circumcision status is related to invasive carcinoma or the cervix, carcinoma in situ, or cervical dysplasia."
4. --------
Am. J. Obstet. Gynecol., July, 1958
Jones, et al.
"The specific items of importance which have been under scrutiny are: dietary deficiency, estrogen excretion levels, menstrual patterns, hygienic practices, contraceptives, circumcision of marital and other partners, and frequency and duration of coitus; for none of these items was there any significant difference between the cases and their matched controls."
But the damage was done, and cervical cancer in partners entered the mythology as yet another "reason" to circumcise babies. Hence this page.
These more recent studies demonstrate that the orginal low incidence of cervical cancer in Israeli Jewish women is genetic. The first shows that women have as many pre-cancerous lesions as other women (suggesting the same exposure to HPV) but they tend not to progress to cancer because of a certain allele (variant) in the p53 gene (whose normal function is to control cell proliferation). In Moroccan Jewish women, who have a high incidence of cervical cancer, the cancer-permitting allele of p53 is more common. These are good studies demonstrating the interaction between genetics and environment. 1. Premalignant lesions of the uterine cervix in a large cohort of Israeli Jewish women. Sadan O, Schejter E, Ginath S, Bachar R, Boaz M, Menczer J, Glezerman M.
Arch Gynecol Obstet. 2004 Mar;269(3):188-91. Epub 2003 Oct 24. Israeli Jewish women are at low risk for cancer of the uterine cervix. In view of absent screening programs in Israel, there are only scarce data available with regard to results of PAP smears. The aim of this study was to assess the incidence of premalignant cervical lesions in the largest sample of PAP smears reported so far from Israel. We retrospectively analyzed the results of 297,849 PAP smears, which had been examined in a single laboratory, during 9 years (1991-1999). The incidence of low- and high-grade squamous intraepithelial was 0.69% and 0.29%, respectively. Our data indicate similar incidence rates for premalignant lesions in Jewish Israeli women as observed in Western countries, but no increase during the study period. In spite of relatively high incidence rates for premalignant lesions of the uterine cervix, the incidence rate for invasive cervical cancer remains conspicuously low. For unknown reason the conversion rate from premalignant cervical lesions to invasive cancer is lower in Israeli Jewish women than in European and North American women. We discuss possible reasons for this phenomenon and suggest that at this time mass screening for cervical cancer in Israel may probably not be justified. PMID: 14576953 [PubMed - in process] 2. Codon 72 polymorphism of p53 in Israeli Jewish cervical cancer patients and healthy women. Arbel-Alon S, Menczer J, Feldman N, Glezerman M, Yeremin L, Friedman E.
Int J Gynecol Cancer. 2002 Nov-Dec;12(6):741-4. Recently it has been found that the presence of homozygous arginine polymorphism at codon 72 of p53, represents a significant risk factor in the development of HPV-associated cervical cancer. The incidence of cervical carcinoma is persistently very low in Israeli Jewish women for unknown reasons. The incidence among those of North African origin is relatively higher. The aim of the present study was to assess the frequency distribution of the p53 homozygous arginine polymorphism in cervical cancer patients and in a population sample of healthy Israeli Jewish women in order to determine whether the incidence pattern among them is genetically based. The cases consisted of 23 Israeli Jewish patients with histologically confirmed squamous cell carcinoma of the cervix. A group of 162 randomly chosen Israeli Jewish healthy participants, considered to represent the general population, comprised the controls. The germline p53 polymorphism at codon 72 was determined by PCR in DNA obtained from a blood sample taken from each subject. Homozygous arginine was found in 34.8% of cases and in only 14.8% of controls. This difference was statistically significant (P = 0.01). The frequency of homozygous arginine polymorphism in controls was lower than in any other population hitherto reported. It was significantly more common among those of North African than among those of other origin (30.3% vs. 10.8%; P < 0.01). It may be assumed that the low incidence of cervical cancer in Israeli Jewish women and the differences between the ethnic groups may be related to the frequency pattern of the homozygous arginine p53 polymorphism PMID: 12445252 [PubMed - indexed for MEDLINE] Humans have two copies of each gene, and a polymorphism means that one gene is slightly different to the other. The open reading frame is a special segment of a gene which acts as an instruction for the cell to synthesize a protein. Proteins are made up of amino acids (there are 20 different amino acids) which link together to form a chain, which can then tie in knots to form three dimensional biomolecules. Proteins are the building blocks of life, and include enzymes, contractile fibres (in cells, especially muscle), and structural fibres. Proteins can also be combined with other molecules such as fats and sugars. A homozygous arginine polymorphism at codon 72 means that the two alleles (two copies of DNA coding for the same protein) are homozygous, or code for the same amino acid (arginine) at position number 72 along the amino acid of the p53 protein. Mutations in the gene coding for another protein (BRCA) have been linked to breast cancer, and Menczer showed that this may also be linked to cervical cancer. Genetic factors are very important for human susceptibility to many infectious diseases, including HIV. The case is summarised in: The low incidence of cervical cancer in Jewish women: has the puzzle finally been solved? Menczer J.
Isr Med Assoc J. 2003 Feb;5(2):120-3. PMID: 12674663 [PubMed - indexed for MEDLINE] |
Cervical cancer has reappeared as a reason to circumcise, with the publication of an article in the New England Journal of Medicine. Here is an analysis of its many flaws.
Back to the Intactivism index page.
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From BBC news, Wednesday, 20 November, 2002, 18:12 GMT
Cervical cancer vaccine success
A vaccine to protect women from one of the biggest cancer killers could be
available within five years.
Early clinical trials of a vaccine for cervical cancer have shown that it is
100% effective. It also protects against genital warts.
The breakthrough could help to save thousands of lives each year.
Cervical cancer is the second most common cancer in women under 35 in the
UK. It claims 1,300 lives each year.
The vaccine works by triggering the body's immune system to attack the human
papiloma virus (HPV), which has been linked to almost all cases of cervical
cancer.
Further trials
The vaccine would be given to teenage girls. It would only work in females
who have not yet become sexually active.
This is because HPV is transmitted through sexual intercourse.
The vaccine fights four of the most common strains of HPV, including a
strain that causes genital warts.
Early trials on almost 2,400 women between the ages of 16 and 23 in the
United States have shown that it reduced the incidence of HPV by 100% after
one year.
Merck Sharp & Dohme is now recruiting 6,000 women worldwide to take part in
phase three trials.
These will include 250 women at centres in Glasgow, London and Nottingham.
If the trials are successful the company will then be able to apply for a
licence to manufacture and sell the vaccine.
A company spokeswoman told BBC News Online: "Recruitment is currently under
way in three centres in the UK. If these phase three trials are successful
then we may have a vaccine within several years."
Professor David Jenkins, who will lead the Nottingham study, said: "What
we're trying now is to see if this can be rolled out into real life and into
preventing cervical cancer. But it will take five years at least."
Breakthrough
"These results look very, very good. People have been trying to get a
vaccine for years and years," she told BBC News Online.
"This is really the holy grail of cancer research. It is very exciting."
But Dr Szarewski warned that the vaccine would not help women who have
already become sexually active.
"This vaccine would have to be given to teenage or young girls who haven't
become sexually active yet.
"An entire generation who have already become sexually active would not
benefit."
But she added: "Once it does become available to a new generation of women
then I see a situation where they will no longer have to have smear tests."
HPVs are a group of more than 80 different types of virus. They can be
transmitted through sexual intercourse.
It is estimated that up to 15% of women aged 20 to 30 women and up to 6% of
women over 40 carry the virus. The majority do not go on to develop cancer.
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