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  |date=2018
  |date=2018
  |accessdate=2020-09-19
  |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>
}}</ref>


== Risk factors ==
== 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.
The major risk factors for penile cancer are advanced age (greater than age 60), use of tobacco, and infection with human papilloma virus.


Line 44: Line 110:
  |pages=92-97
  |pages=92-97
  |url=https://jamanetwork.com/journals/jama/article-abstract/453164
  |url=https://jamanetwork.com/journals/jama/article-abstract/453164
|pubmedID=
|pubmedCID=
|DOI=
|doi=10.1001/jama.1914.02560270008003
  |accessdate=2023-09-06
  |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
}}</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
Line 56: Line 126:
  |date=1963-04
  |date=1963-04
  |pages=414-420
  |pages=414-420
|pubmedID=13973496
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-06
}}</ref> circumcision advocates continue to stubbornly repeat it.
}}</ref> circumcision advocates continue to stubbornly repeat it.


Line 79: Line 154:
  |volume=32
  |volume=32
  |pages=15-21
  |pages=15-21
|pubmedID=2991988
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-07
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=Kaufman
  |last=Kaufman
Line 89: Line 169:
  |volume=3
  |volume=3
  |pages=678-692
  |pages=678-692
|pubmedID=3019599
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-07
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=McCance
  |last=McCance
Line 103: Line 188:
  |volume=37
  |volume=37
  |pages=55-59
  |pages=55-59
|pubmedID=3000954
|pubmedCID=
|DOI=10.1002/ijc.2910370110
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=Villa
  |last=Villa
Line 114: Line 204:
  |issue=6
  |issue=6
  |pages=853-5
  |pages=853-5
|pubmedID=3000954
|pubmedCID=
|DOI=
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=McCance
  |last=McCance
Line 122: Line 217:
  |issue=823
  |issue=823
  |pages=195-206
  |pages=195-206
|pubmedID=3011085
|pubmedCID=
|DOI=10.1016/0304-419x(86)90002-8
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=Barrasso
  |last=Barrasso
Line 136: Line 236:
  |issue=15
  |issue=15
  |pages=916-23
  |pages=916-23
}}</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
|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
  |last=Poland
  |init=RL
  |init=RL
|author-link=Ronald L. Poland
  |url=http://www.cirp.org/library/general/poland/
  |url=http://www.cirp.org/library/general/poland/
  |title=The question of routine neonatal circumcision
  |title=The question of routine neonatal circumcision
Line 145: Line 251:
  |volume=322
  |volume=322
  |pages=1312-5
  |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
}}</ref> At least one study suggests that [[circumcised]] men are at higher risk for HPV infection,<ref name="cook1993">{{REFjournal
  |last=Cook
  |last=Cook
Line 158: Line 268:
  |volume=69
  |volume=69
  |pages=262-4
  |pages=262-4
}}</ref> making being [[circumcised]] a risk factor.
|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===
===Use of tobacco===
Line 179: Line 294:
  |issue=6609
  |issue=6609
  |pages=1306-8
  |pages=1306-8
}}</ref>The use of tobacco has since been a well established risk factor in cancer of the penis.<ref>{{REFjournal
|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
  |last=Harish
  |init=K
  |init=K
Line 191: Line 311:
  |issue=3
  |issue=3
  |pages=375-377
  |pages=375-377
|pubmedID=7735804
|pubmedCID=
|DOI=10.1111/j.1464-410x.1995.tb07352.x
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=Rogus
  |last=Rogus
Line 200: Line 325:
  |issue=4
  |issue=4
  |pages=861-2
  |pages=861-2
|pubmedID=3656549
|pubmedCID=
|DOI=10.1016/s0022-5347(17)43402-1
|doi=
|accessdate=2023-09-08
}}</ref><ref>{{REFjournal
}}</ref><ref>{{REFjournal
  |last=Maden
  |last=Maden
Line 210: Line 340:
  |date=1993-01-06
  |date=1993-01-06
  |pages=19-24
  |pages=19-24
|pubmedID=8380060
|pubmedCID=
|DOI=10.1093/jnci/85.1.19
|doi=
|accessdate=2023-09-08
}}</ref>
}}</ref>


Line 226: Line 361:
  |issue=2
  |issue=2
  |pages=199-203
  |pages=199-203
|pubmedID=2547727
|pubmedCID=
|DOI=10.1002/ijc.2910440202
|doi=
|accessdate=2023-09-08
}}</ref>
}}</ref>
===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]].)


===Circumcision as a risk factor===
===Circumcision as a risk factor===


Bissada et al. (1986) report cancer forms on the [[circumcision scar]].<ref name="bissada1986">{{REFjournal
Bissada et al. (1986) reported cancer forms on the [[circumcision scar]].<ref name="bissada1986">{{REFjournal
  |last=Bissada
  |last=Bissada
  |init=NK
  |init=NK
Line 269: Line 394:
  |DOI=10.1016/s0022-5347(17)45614-x
  |DOI=10.1016/s0022-5347(17)45614-x
  |accessdate=2020-02-10
  |accessdate=2020-02-10
}}</ref> Circumcision may now be considered a risk factor for penile cancer.
}}</ref> The [[circumcision scar]] may provide an entry point for HIV. [[Circumcision]] 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 ==
== Symptoms ==
Line 352: Line 496:
  |title=The question of routine neonatal circumcision
  |title=The question of routine neonatal circumcision
  |journal=New Engl J Med
  |journal=New Engl J Med
|url=https://www.cirp.org/library/general/poland/
  |date=1990
  |date=1990
  |volume=322
  |volume=322
  |issue=18
  |issue=18
  |pages=1312-4
  |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
}}</ref> As cases of penile cancer in circumcised men begin to accumulate<ref>{{REFjournal
  |last=Pec Jr
  |last=Pec Jr
Line 497: Line 648:
  |doi=
  |doi=
  |accessdate=2023-09-05
  |accessdate=2023-09-05
}}</ref> The medical literature contains numerous additional case report of cancer in [[circumcised]] men.
}}</ref> The medical literature contains numerous additional case reports of cancer in [[circumcised]] men.


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.
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.
=== Discussion ===
=== Discussion ===
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
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
  |last=Cook
  |last=Cook
  |init=LS
  |init=LS
Line 515: Line 666:
}}</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]].
}}</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
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
  |last=Reddy
  |init=CR
  |init=CR
Line 527: Line 678:
  |volume=60
  |volume=60
  |pages=474-6
  |pages=474-6
}}</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
|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
  |last=Kochen
  |init=M
  |init=M
Line 560: Line 716:
  |pages=31-37
  |pages=31-37
}}</ref>
}}</ref>
 
Rosemary Romberg (2021) explained:
== Incidence of penile cancer ==
<blockquote>
 
Both ''politics'' and ''economics'' are strongly involved in this issue. Far too often many choices in human health care have not centered on what is best for the individual. Instead they have centered on who is in ''control'' and who is getting ''paid''. A doctor is the person in ''control'' when he performs a circumcision. He cannot ''control'' whether or not that person is going to wash himself. Similarly, doctors get ''paid'' for doing circumcisions, but they do not get ''paid'' for telling people to wash.<ref name="romberg2021">{{REFbook
In North America the rate of penile cancer has been estimated to be 1 in 100,000<ref>{{REFdocument
  |last=Romberg
|last=Cutler
  |first=Rosemary
|init=SJ
  |init=
|last2=Young Jr
  |author-link=Rosemary Romberg
|init2=JL
  |year=2021
|title=Third national cancer survey: incidence data
  |title=Circumcision — The Painful Dilemma
|location=Bethesda, {{USSC|MD}}
  |url=https://circumcisionthepainfuldilemma.wordpress.com/
|publisher=US Dept of Health, Education, and Welfare, Public Health Service
  |work=
|date=1975
  |editor=[[Ulf Dunkel]]
}}</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
  |edition=Second Edition, Revised
  |last=Maden
  |volume=
  |init=C
  |chapter=Conclusions
  |last2=Sherman
  |scope=
  |init2=KJ
  |page=328
  |last3=Beckman
  |pages=
  |init3=AM
  |location=
  |last4=Hislop
  |publisher=Kindle
  |init4=TG
  |ISBN=23: 979-8683021252
  |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 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=
  |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=
  |accessdate=2023-08-31
|archived=yes
  |note=
|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>
}}</ref>
</blockquote>


== HPV vaccine ==
== HPV vaccine ==
Retrieved from "https://en.intactiwiki.org/wiki/Penile_cancer"