Circumcision to prevent penile cancer?

By Jeff Graw, Intact Colorado

Estimated genital cancers in the U.S. (Vulvar and Penile Cancer rates) from Cancer.gov and Cancer.org

Why do we always hear that circumcision reduces your chances of getting penile cancer, but no one ever recommends female circumcision to reduce the chances of vulvar cancer? Three times more women will get (external) genital cancers, and three times more women will die from these this year compared to men. [1-2]

Pro-circumcision fanatic, Edgar Schoen, would like us to believe that penile cancer would drop significantly if all boys were circumcised, and that if no one was circumcised, the penile cancer rate would double. [3] Even if this were true, women would still be almost twice as likely as men to get cancer in the external genitalia. Female circumcision, then, would be more effective at reducing cancer rates than male circumcision is.

Schoen also states that the statistics from Israel prove the benefits; the penile cancer rate there is 0.1 per 100,000 compared to 1.0 per 100,000 in Denmark. We must always be careful with these kinds of statistics because they can be misleading. Consider just one factor: penile cancer incidence versus age distribution. Only 10.5% of Israel’s population is over 65 years old [4], whereas 18% of Denmark’s population is over 65 [5], and most penile cancer occurs in men over 65 [6]. This one factor alone cuts the 10x benefit of circumcision in half. [7]

Another group of researchers published that intact men (in the same demographic) were 3.2 times more likely to have penile cancer. [8] However when we consider that circumcision removes about half of the skin on the penis [9-10], we see that the benefit is only slightly greater than the amount of tissue removed. The benefit provided by circumcision is further reduced if phimosis is properly diagnosed and treated. Phimosis is diagnosed in adults, not children [11]; it is a condition where the foreskin does not retract to allow proper hygiene; it affects about 1% of intact men [12]. Phimosis is easily treatable; treatment costs are low, and most of the time surgical intervention is unnecessary. [13-15] Another group of researchers suggests that phimosis increases the risk of penile cancer by a factor of 16. [16] When phimosis is factored out, intact men are actually half as likely to have invasive penile cancer as circumcised men, as acknowledged by the American Academy of Pediatrics:
In fact, in men with an intact prepuce and no phimosis, there is a decreased risk of invasive penile cancer (OR: 0.5). [This] suggests that the benefit of circumcision is conferred by reducing the risk of phimosis. [17]
Considering that phimosis is easily treated, circumcision actually increases the risk of penile cancer.

Can this result be correct? Possibly; keep in mind that the foreskin has immunological capabilities, and so is able to fight disease. [18] So the endless discussions and studies by Schoen and others are meaningless distractions from the final result. Circumcision is then an invasive surgical alternative to simple hygiene. Despite the obvious conclusion, the AAP still makes the following statement about circumcision and penile cancer reduction:
It is difficult to establish how many male circumcisions it would take to prevent a case of penile cancer, and at what cost economically and physically. One study with good evidence estimates that based on having to do 909 circumcisions to prevent 1 penile cancer event, 2 complications would be expected for every penile cancer event avoided. However, another study with fair evidence estimates that more than 322 000 newborn circumcisions are required to prevent 1 penile cancer event per year. This would translate into 644 complications per cancer event, by using the most favorable rate of complications, including rare but significant complications. The clinical value of the modest risk reduction from circumcision for a rare cancer is difficult to measure against the potential for complications from the procedure. In addition, these findings are likely to decrease with increasing rates of HPV vaccination in the United States. [17]
The American Cancer Society has been an outspoken opponent of infant circumcision in the prevention of both penile and cervical cancers, claiming that circumcision is not a “valid or effective measure to prevent such cancers.” [19] The ACS believes that the incidence of penile and cervical cancers can be significantly reduced without cutting off body parts. Not smoking and good hygiene are big factors in prevention, but the ACS also believes that vaccines against HPV should also be used. [20]

Two types of HPV (types 16 and 18) are responsible for 70% of all cervical cancers and nearly half of all vaginal, vulvar, and penile cancers. [21] How effective are the HPV vaccines? “The trials demonstrated nearly 100% vaccine efficacy in preventing cervical precancers, vulvar and vaginal precancers, and genital warts in women caused by the vaccine types, as well as 90% vaccine efficacy in preventing genital warts and 75% vaccine efficacy in preventing anal precancers in men.” [22] The same benefits should be observed for penile cancer, but because penile cancers are not seen until old age, the results are not yet fully known. Circumcision is 19th century medicine; today we have better solutions than cutting our genitals.

References

[1] http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-key-statistics
[2] http://www.cancer.gov/cancertopics/pdq/treatment/vulvar/HealthProfessional/page1
[3] http://pediatrics.aappublications.org/content/105/3/e36.full
[4] https://www.cia.gov/library/publications/the-world-factbook/geos/is.html
[5] https://www.cia.gov/library/publications/the-world-factbook/geos/da.html
[6] http://menshealth.about.com/od/cancer/a/cancer_penis.-0FR.htm
[7] http://circumcisionthepainfuldilemma.wordpress.com/table-of-contents/chapter-14/ See discussion comparing prostatic cancer between Sweden and Israel.
[8] http://jnci.oxfordjournals.org/content/85/1/19.abstract?ijkey=f732b0a0f58a9a7c8809c7dd65f6cd5bde299db5&keytype2=tf_ipsecsha
[9] https://www.youtube.com/watch?v=Ceht-3xu84I
[10] http://www.foreskin.org/3zones-c.htm
[11] http://www.cirp.org/library/general/oster/
[12] http://www.freemd.com/phimosis/
[13] https://tspace.library.utoronto.ca/bitstream/1807/7009/1/js05033.pdf Caution should be exercised in reading this; their diagnosis of phimosis in boys is now outdated. Nevertheless, the treatment results show a very high success rate.
[14] http://www.freemd.com/balanitis/overview.htm This is the treatment for actual adult phimosis caused by various infections.
[15] http://www.phimocure.net/ This is treatment for actual adult phimosis caused by a physical narrowing of the foreskin end.
[16] http://www.ncbi.nlm.nih.gov/pubmed/11405332
[17] http://pediatrics.aappublications.org/content/130/3/e756.full.pdf+html
[18] http://www.gr8birth.com/circumcision.html
[19] http://www.cirp.org/library/statements/letters/1996-02_ACS/
[20] http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-prevention
[21] http://www.cancer.gov/cancertopics/factsheet/Risk/HPV#r7
[22] http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm

American Cancer Society 2017 Statistics

Read more from Graw:

HIV in the Circumcised U.S. up to 500% Higher than Intact Nations 

Void of Empathy: Medical Professionals Joke About Circumcision

American Cancer Society: 2014 statistics



4 comments:

  1. Amazing, isn't it, that we are not instead focused on removing the breast buds of baby boys... (sarcasm)

    In 2014: "About 1,570 new cases of penile cancer will be diagnosed. Penile cancer occurs among less than 1 man in 100,000"

    In 2014: "About 2,240 new cases of invasive breast cancer will be diagnosed among men. For men, the lifetime risk of getting breast cancer is about 1 in 1,000."

    http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-key-statistics

    http://www.cancer.org/cancer/breastcancerinmen/detailedguide/breast-cancer-in-men-key-statistics

    ReplyDelete
  2. I ♥ my foreskin. Thanks, mom & dad!

    ReplyDelete
  3. My mother was lied to, his cutting of my penis was done to make money for him. He probably didn't care that MY penis was ruined.

    ReplyDelete

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