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===Other risks===
[[Phimosis]] has been implicated as a risk factor in sexually active males, because a non-retractile [[foreskin]] may result in poor hygiene, and because men with [[phimosis]] are at higher risk for lichen sclerosus (also known as [[balanitis xerotica obliterans]]), which may also be a risk factor.<ref name="Rickwood">{{REFjournal
|url=http://web.archive.org/web/20080513042221/http://bmj.bmjjournals.com/cgi/eletters/321/7264/792
|REM=http://web.archive.org/web/20080513042221/http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919
|archived=yes
|title=Rapid Responses for Rickwood et al.
|last=Various authors
|first=
|journal=BMJ
|volume=321
|issue=7264
|pages=792-3
|accessdate=2022-03-13
}}</ref> Adult males with a non-retractable [[foreskin]] who are sexually active may want to have the phimotic condition corrected. (For conservative treatment options, see [[phimosis]].)
→Other risks
|date=2018
|accessdate=2020-09-19
}}</ref>
== Incidence of penile cancer ==
In North America the rate of penile cancer has been estimated to be 1 in 100,000<ref>{{REFdocument
|last=Cutler
|init=SJ
|last2=Young Jr
|init2=JL
|title=Third national cancer survey: incidence data
|location=Bethesda, {{USSC|MD}}
|publisher=US Dept of Health, Education, and Welfare, Public Health Service
|date=1975
}}</ref>. Maden et al. (1993) reported penile cancer among a fifth of elderly patients from rural areas who had been [[circumcised]] neonatally and had been born at a time when the rate of neonatal [[circumcision]] was about 20% in rural populations.<ref>{{REFjournal
|last=Maden
|init=C
|last2=Sherman
|init2=KJ
|last3=Beckman
|init3=AM
|last4=Hislop
|init4=TG
|last5=Teh
|init5=CZ
|last6=Ashley
|init6=RL
|etal=yes
|url=http://www.cirp.org/library/disease/cancer/maden/
|title=History of circumcision, medical conditions, and sexual activity and risk of penile cancer
|journal=JNCI
|date=1993
|volume=85
|pages=19-24
|pubmedID=8380060
|pubmedCID=
|DOI=10.1093/jnci/85.1.19
|doi=
|accessdate=2023-09-07
}}</ref> Their study also shows that the rate of penile cancer among men [[circumcised]] neonatally has risen in the United States relative to the rise in the rate of neonatal circumcision.
Penile cancer is very rare in Europe and North America, occurring in about one in 100,000 men in the latter. It accounts for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States. However, in some parts of Africa and South America it accounts for up to 10% of cancers in men.<ref name="What Are the Key Statistics About Penile Cancer?">{{REFweb
|quote=
|url=http://web.archive.org/web/20071030194444/http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_penile_cancer_35.asp?sitearea=
|archived=yes
|title=ACS :: What Are the Key Statistics About Penile Cancer?
|last=
|first=
|publisher=
|website=
|date=2007-10-30
|accessdate=2007-12-13
}}</ref>
In Japan, Norway, and Sweden, the risk of penile cancer is about the same as in the US (1 in 100,000 per year).<ref>{{REFjournal
|last=Wallerstein
|init=E
|title=Circumcision. The uniquely American medical enigma
|journal=Urol Clin North Am
|volume=12
|issue=1
|pages=123-32
|url=http://www.cirp.org/library/general/wallerstein/
|quote=
|pubmedID=3883617
|pubmedCID=
|DOI=
|date=1985-02
|accessdate=2020-02-10
}}</ref>
== Risk factors ==
The major risk factors for penile cancer are advanced age (greater than age 60), use of tobacco, and infection with human papilloma virus.
|pages=92-97
|url=https://jamanetwork.com/journals/jama/article-abstract/453164
|pubmedID=
|pubmedCID=
|DOI=
|doi=10.1001/jama.1914.02560270008003
|accessdate=2023-09-06
}}</ref> epilepsy, paralysis, and [[masturbation]].<ref>{{Wolbarst1932}}</ref> No laboratory or clinical research had been done on the subject at the time, however Wolbarst's myth found its way into early medical textbooks regardless. Although the smegma hypothesis was completely disproven by an exhaustive study by Reddy in 1963,<ref name="reddy1963">{{REFjournal
|volume=32
|pages=15-21
|pubmedID=2991988
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-07
}}</ref><ref>{{REFjournal
|last=Kaufman
|volume=3
|pages=678-692
|pubmedID=3019599
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-07
}}</ref><ref>{{REFjournal
|last=McCance
|volume=37
|pages=55-59
|pubmedID=3000954
|pubmedCID=
|DOI=10.1002/ijc.2910370110
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
|last=Villa
|issue=6
|pages=853-5
|pubmedID=3000954
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
|last=McCance
|issue=823
|pages=195-206
|pubmedID=3011085
|pubmedCID=
|DOI=10.1016/0304-419x(86)90002-8
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
|last=Barrasso
|issue=15
|pages=916-23
|pubmedID=3041217 |pubmedCID= |DOI= |doi= |accessdate=2023-09-08}}</ref> [[Ronald L. Poland | Poland]] identified human papilloma virus (HPV) types 16 and 18 as the cause of penile and cervical cancers in 1990, and that they could be spread by sexual contact.<ref name="poland1990">{{REFjournal
|last=Poland
|init=RL
|author-link=Ronald L. Poland
|url=http://www.cirp.org/library/general/poland/
|title=The question of routine neonatal circumcision
|volume=322
|pages=1312-5
|pubmedID=2183058
|pubmedCID=
|DOI=10.1056/NEJM199005033221811
|accessdate=2023-09-07
}}</ref> At least one study suggests that [[circumcised]] men are at higher risk for HPV infection,<ref name="cook1993">{{REFjournal
|last=Cook
|volume=69
|pages=262-4
|pubmedID=7721284 |pubmedCID=1195083 |DOI=10.1136/sti.69.4.262 |doi= |accessdate=2023-09-07 }}</ref> making being [[circumcised]] a risk factor.
===Use of tobacco===
|issue=6609
|pages=1306-8
|pubmedID=3120988 |pubmedCID=1248379 |DOI=10.1136/bmj.295.6609.1306 |doi= |accessdate=2023-09-08}}</ref>The use of tobacco has since been a well established risk factor in cancer of the penis.<ref>{{REFjournal
|last=Harish
|init=K
|issue=3
|pages=375-377
|pubmedID=7735804
|pubmedCID=
|DOI=10.1111/j.1464-410x.1995.tb07352.x
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
|last=Rogus
|issue=4
|pages=861-2
|pubmedID=3656549
|pubmedCID=
|DOI=10.1016/s0022-5347(17)43402-1
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
|last=Maden
|date=1993-01-06
|pages=19-24
|pubmedID=8380060
|pubmedCID=
|DOI=10.1093/jnci/85.1.19
|doi=
|accessdate=2023-09-08
}}</ref>
|issue=2
|pages=199-203
|pubmedID=2547727
|pubmedCID=
|DOI=10.1002/ijc.2910440202
|doi=
|accessdate=2023-09-08
}}</ref>
===Circumcision as a risk factor===
Bissada et al. (1986) report reported cancer forms on the [[circumcision scar]].<ref name="bissada1986">{{REFjournal
|last=Bissada
|init=NK
|DOI=10.1016/s0022-5347(17)45614-x
|accessdate=2020-02-10
}}</ref> The [[circumcision scar]] may provide an entry point for HIV. [[Circumcision may ]] should now be considered a risk factor for penile cancer. ===Other risks===[[Phimosis]] has been implicated as a risk factor in sexually active males, because a non-retractile [[foreskin]] may result in poor hygiene, and because men with [[phimosis]] are at higher risk for lichen sclerosus (also known as [[balanitis xerotica obliterans]]), which may also be a risk factor.<ref name="Rickwood">{{REFjournal |url=http://web.archive.org/web/20080513042221/http://bmj.bmjjournals.com/cgi/eletters/321/7264/792 |REM=http://web.archive.org/web/20080513042221/http://bmj.bmjjournals.com/cgi/eletters/321/7264/792#110919 |archived=yes |title=Rapid Responses for Rickwood et al. |last=Various authors |first= |journal=BMJ |volume=321 |issue=7264 |pages=792-3|pubmedID= |pubmedCID= |DOI= |doi= |accessdate=2022-03-13}}</ref> Adult males with a non-retractable [[foreskin]] who are sexually active may want to have the phimotic condition corrected. (For conservative treatment options, see [[phimosis]].)
== Symptoms ==
|title=The question of routine neonatal circumcision
|journal=New Engl J Med
|url=https://www.cirp.org/library/general/poland/
|date=1990
|volume=322
|issue=18
|pages=1312-4
|pubmedID=2183058
|pubmedCID=
|DOI=10.1056/NEJM199005033221811
|doi=
|accessdate=2023-09-06
}}
}}</ref> As cases of penile cancer in circumcised men begin to accumulate<ref>{{REFjournal
|last=Pec Jr
}}</ref><ref name="cook1993"/> and HPV lesions are equally common in [[circumcised]] and [[intact]] men.<ref name="Aynaud etal 1994"/> As the number of [[circumcised]] men approaching the age at which penile cancer becomes evident (70s and 80s) it is quite likely that the vast majority of men developing penile cancer in the [[United States]] will be [[circumcised]].
Reddy et al. (1975) examined the frequency of carcinoma of the penis from 32 hospitals in India and found a wide variation in incidence that could not be explained by the [[intact]] status of the Hindus or the [[circumcision]] practices of the Muslims. <ref name="reddy1975">{{REFjournal
|last=Reddy
|init=CR
|volume=60
|pages=474-6
|pubmedID=54346
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-08
}}</ref> Finally, circumcision does not explain why Japan and [[Denmark]] have lower penile cancer rates than the [[United States]] when circumcision, especially infant [[circumcision]], is not common in those two countries.<ref name="kochen1980">{{REFjournal
|last=Kochen
|pages=31-37
}}</ref>
Rosemary Romberg (2021) explained:== Incidence of penile cancer == In North America the rate of penile cancer has been estimated to be 1 in 100,000<refblockquote>{{REFdocument |last=Cutler |init=SJ |last2=Young Jr |init2=JL |title=Third national cancer survey: incidence data |location=Bethesda, {{USSC|MD}} |publisher=US Dept of Health, Education, Both ''politics'' and Welfare, Public Health Service |date=1975}}</ref>''economics'' are strongly involved in this issue. Maden et alFar too often many choices in human health care have not centered on what is best for the individual. (1993) reported penile cancer among a fifth of elderly patients from rural areas Instead they have centered on who had been circumcised neonatally is in ''control'' and had been born at who is getting ''paid''. A doctor is the person in ''control'' when he performs a time when the rate of neonatal circumcision was about 20% in rural populations.<ref>{{REFjournal |last=Maden |init=C |last2=Sherman |init2=KJ |last3=Beckman |init3=AM |last4=Hislop |init4=TG |last5=Teh |init5=CZ |last6=Ashley |init6=RL |etal=yes |url=http://www.cirp.org/library/disease/cancer/maden/ |title=History of circumcision, medical conditions, and sexual activity and risk of penile cancer |journal=JNCI |date=1993 |volume=85 |pages=19-24}}</ref> Their study also shows He cannot ''control'' whether or not that the rate of penile cancer among men circumcised neonatally has risen in the United States relative person is going to the rise in the rate of neonatal circumcisionwash himself. Penile cancer is very rare in Europe and North America, occurring in about one in 100Similarly,000 men in the latter. It accounts doctors get ''paid'' for 0.2% of cancers and 0.1% of deaths from cancer amongst males in the United States. Howeverdoing circumcisions, in some parts of Africa and South America it accounts but they do not get ''paid'' for up telling people to 10% of cancers in menwash.<ref name="What Are the Key Statistics About Penile Cancer?romberg2021">{{REFwebREFbook |quotelast=Romberg |url=http://web.archive.org/web/20071030194444/http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_penile_cancer_35.asp?siteareafirst=Rosemary |archivedinit=yes |titleauthor-link=ACS :: What Are the Key Statistics About Penile Cancer?Rosemary Romberg |lastyear=2021 |firsttitle=Circumcision — The Painful Dilemma |publisherurl=https://circumcisionthepainfuldilemma.wordpress.com/ |websitework= |dateeditor=2007-10-30[[Ulf Dunkel]] |accessdateedition=2007-12-13}}</ref> In Japan, Norway, and Sweden, the risk of penile cancer is about the same as in the US (1 in 100Second Edition,000 per year).<ref>{{REFjournalRevised |lastvolume=Wallerstein |initchapter=EConclusions |titlescope=Circumcision. The uniquely American medical enigma |journalpage=Urol Clin North Am328 |volumepages=12 |issuelocation=1 |pagespublisher=123-32Kindle |urlISBN=http23://www.cirp.org/library/general/wallerstein/979-8683021252
|quote=
|pubmedIDaccessdate=3883617 |pubmedCID= |DOI= |date=19852023-08-0231 |accessdatenote=2020-02-10
}}</ref>
</blockquote>
== HPV vaccine ==