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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">Cook LS, Koutsky LA, Holmes KK. Circumcision and sexually transmitted diseases. ''Am J Public Health'' 1994; 84: 197-201.</ref> <ref name="cook1993" /> and HPV lesions are equally common in circumcised and intact men.<ref>Aynaud O, Ionesco M; Barrasso R. Penile intraepithelial neoplasia. Specific clinical features correlate with histologic and virologic findings. Cancer 1994; 74: 1762-7.]</ref> 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">Reddy CR, Raghavaiah NV, Mouli KC. Prevalence of carcinoma of the penis with special reference to India. ''Int Surg'' 1975, 60: 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
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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>Hyman AB; Brownstein MH. Tyson's "Glands," ''Archives of Dermatology'', vol. 99, no. 1 (January 1969): pp. 31-37</ref>
== Incidence of penile cancer ==