Changes

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 [[Brit Milah| ritual circumcision ]] named [[Abraham L. Wolbarst]], who also believed that [[circumcision]] prevented venereal disease,<ref name="wolbarst1914">{{REFjournal |last=Wolbarst |first=Abraham L. |init=AL |author-link=Abraham L. Wolbarst |title=Universal Circumcision as a Sanitary Measure |journal=JAMA |date=1914-1-10 |volume=62 |issue=2 |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

|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

|pubmedID=7721284 |pubmedCID=1195083 |DOI=10.1136/sti.69.4.262 |doi= |accessdate=2023-09-07 }}</ref> making being [[circumcised]] a risk factor.

|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

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

}}</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]].)

}}</ref> The medical literature contains numerous additional case report reports of cancer in [[circumcised]] men.

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

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

|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

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. 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.<refname="romberg2021">{{REFjournalREFbook |last=MadenRomberg |initfirst=CRosemary |last2init=Sherman |init2author-link=KJRosemary Romberg |last3year=Beckman2021 |init3title=AMCircumcision — The Painful Dilemma |last4url=Hislophttps://circumcisionthepainfuldilemma.wordpress.com/ |init4work=TG |last5editor=Teh[[Ulf Dunkel]] |init5edition=CZSecond Edition, Revised |last6=Ashley |init6volume=RL |etalchapter=yesConclusions |urlscope=http://www.cirp.org/library/disease/cancer/maden/ |titlepage=History of circumcision, medical conditions, and sexual activity and risk of penile cancer328 |journalpages=JNCI |datelocation=1993 |volumepublisher=85Kindle |pagesISBN=1923: 979-24}}</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?">{{REFweb8683021252

|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=1232023-32 |url=http://www.cirp.org/library/general/wallerstein/ |quote= |pubmedID=3883617 |pubmedCID= |DOI= |date=198508-0231 |accessdatenote=2020-02-10

Infection with human papilloma virus (HPV } is associated with some many 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