Penile cancer: Difference between revisions

The myth that [[smegma]] was a carcinogenic, and thus that [[circumcision]] would render a man immune to penile cancer, was invented in 1932 by a defender of ritual circumcision named [[Abraham L. Wolbarst]], who also believed that circumcision prevented epilepsy, paralysis, and [[masturbation]].<ref>{{REFjournal

  |init=A

  |title=Circumcision and Penile Cancer

  |journal=The Lancet

  |volume=1

  |issue=5655

  |date=1932-01-16

  |pages=150-153

}}</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>{{REFjournal

}}</ref> 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

}}</ref> At least one study suggests that circumcised men are at higher risk for HPV infection,<ref name="cook1993">{{REFjournal

  |title=Clinical presentation of genital warts among circumcised and [[uncircumcised]] heterosexual men attending an urban STD clinic

}}</ref> making being circumcised a risk factor.

}}</ref>The use of tobacco has since been a well established risk factor in cancer of the penis.<ref>{{REFjournal

Bissada et al. (1986) report cancer forms on the [[circumcision scar]].<ref name="bissada1986">{{REFjournal

}}</ref> Circumcision may now be considered a risk factor for penile cancer.

The myth that circumcision rendered males immune to penile cancer was invented in 1932 by a New York doctor named [[Abraham L. Wolbarst]], {{MD}}<ref name="Wolbarst 1932">{{Wolbarst1932}}</ref> Wolbarst wrote an article that was published in ''The Lancet'' in 1932, implicating human male [[smegma]] as carcinogenic.<ref name="Wolbarst 1932"/> His hypothesis had absolutely no basis in valid scientific and epidemiological research.<ref name="FleissPM HodgesFM 1996">{{REFjournal

Wolbarst's opinion piece led to the perpetuation of the myth that penile cancer could not happen to males that were circumcised in infancy. This myth was completely disproven when Boczko et al. (1979) reported the 9th documented case of penile cancer in a man who had been circumcised in infancy from the time of Wolbarst's opinion piece to the time of the report in 1968 (though they would maintain that "performing [circumcision] in infancy continues to be the most effective prophylactic measure against penile carcinoma").<ref name="boczko1979">{{REFjournal

}}</ref> Boczko et al. (1979) wrote: ''"The diagnosis in our patient was made late, as in the other cases reported, perhaps because the disease was presumed not to occur in those circumcised in infancy. This is clearly not so. Although rare, the diagnosis must be considered when evaluating a penile lesion even in a circumcised individual."''

In 1993, Christopher Maden, {{PhD}}, et al. reported a study in which 110 men with penile cancer, diagnosed from January 1979, to July, 1990, were interviewed. Of these 110 men, 22 had been circumcised at birth, 19 later in life, and 69 never.<ref>{{REFjournal

}}</ref>, it becomes clear that the assertion that circumcision eliminates the risk of penile cancer is categorically false, although some circumcision advocates continue to make this assertion.

 

Advocates of circumcision may yet point to the aforementioned studies and highlight that the incidence of penile cancer was still lower in the circumcised groups of men studied, than it was in the intact group, and that thus "a lowered risk of penile cancer is observed in circumcised men." It is important to remember when looking at the studies performed in the 1950s, that the octogenarians afflicted with penile cancer were born in the 1870s, when the circumcision rate in the United States was close to zero; the majority of men in that generation who were afflicted with cancer would be intact. The increased number of cases of penile cancer found in more recent studies is reflective of the steadily increasing circumcision rates in this country (37% of Maden's cases were circumcised). Using Maden's numbers and properly adjusting his control population to match the case population for age, there was no difference in risk of developing penile cancer between men who were circumcised and those who were not. HPV (the cause of genital warts) has been found in most cases of penile cancer. Genital warts are now more common in circumcised men <ref name="cook1994">{{REFjournal

}}</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

}}</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

In "[[Circumcision: An American Health Fallacy]]," [[Edward Wallerstein]] writes: ''"If infant circumcision reduces penile cancer we could expect to see proportionately less penile cancer in circumcising nations as compared to noncircumcising ones. No such difference is found."'' Wallerstein reports that, for various years between 1966 and 1972, the annual rate of new cases of penile cancer was 0.8 for the United States (where circumcision rates are high), and 0.5 for Finland, 0.9 for [[Denmark]] and 1.1 for both Norway and Sweden (all of where circumcision rates are low). None of these differences is statistically significant.<ref>{{WallersteinE 1980}}</ref> Further, within the same time frame, both France and the United States had the same rate, 0.3, of deaths due to penile cancer.<ref>{{REFjournal

 

 

In North America the rate of penile cancer has been estimated to be 1 in 100,000<ref>{{REFdocument

|publisher=US Dept of Health, Education, and Welfare, Public Health Service

}}</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

|url=http://www.cirp.org/library/disease/cancer/maden/

}}</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

 

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/

  |pubmedID=3883617

|date=1985-02

  |accessdate=2020-02-10

Infection with HPV is associated with some penile cancers.  A quadri-valent vaccine ([[Gardasil]]) to prevent infection by the four most common variants of HPV has been developed, successfully tested, and approved by the US [[Food and Drug Administration]] for females between the ages of 9 and 26, and as of 2009, males between the ages of 16 and 26.<ref name="Nature Reviews Drug Discovery">{{REFjournal

  |publisher=Doctors Opposing Circumcision