Circumcision Linked to Lower Risk of Prostate Cancer

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A new study published in the journal Cancer found that circumcision may help protect against prostate cancer [1]. The research suggests that circumcision can hinder infection and inflammation that may lead to prostate carcinogenesis.

Micrograph of prostate cancer


Circumcision is a relatively common procedure in which the foreskin of the penis is surgically removed. According to U.S. Centers for Disease Control and Prevention, around 55% of newborn boys are circumcised in hospital [2], while an additional (but unreported) percentage are circumcised in religious ceremonies shortly after birth.

The procedure is not without controversy; medical practitioners and organizations are split on whether circumcision should be routinely performed on newborns. The American Academy of Pediatrics does not currently make a recommendation regarding routine infant circumcision [3]. While there are some minor risks associated with the procedure (as with any minor surgery), there is currently no strong, well-conducted scientific research demonstrating physical or psychological harm, or loss of function associated with circumcision. Much of the concern regarding routine infant circumcision is of an ethical nature, as some physicians struggle to justify a surgical alteration that may not be medically necessary.

Mounting evidence, however, supports the health benefits of circumcision. In a commentary published in the journal Pediatrics, Dr. Edgar Schoen notes that studies show a significant reduction in the risk of HPV and HIV infection, urinary tract infection, penile cancer, and certain STDs in circumcised men. Female partners of circumcised men are less likely to contract STDs, and have lower rates of cervical cancer [4]. The lower rates of disease are due in part to the generally improved hygiene of a circumcised penis, and in part to the presence of receptors for certain viruses — including HIV — in the foreskin [5].

Researchers from the University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center in Seattle, Washington, analyzed information from 3,399 men. They compared data from a group of 1,754 men circumcised before their first sexual intercourse with a control group of 1,645 men who were uncircumcised. The circumcised men had a 15% lower rate of prostate cancer. While this study was not randomized (and it’s therefore possible that the circumcised men shared other genetic traits or behavioral factors that reduced their risk of cancer), it’s nevertheless an interesting correlation. Further, given that many cancers are now linked to viral infection and given the reduced risk of several viral infections associated with circumcision, these findings fall well within the confines of the scientifically plausible.

According to Dr. Jonathan Wright, lead author on the study and an assistant professor of urology at the University of Washington School of Medicine [6]:

These data are in line with an infectious/inflammatory pathway which may be involved in the risk of prostate cancer in some men. Although observational only, these data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer. Future research of this relationship is warranted.

References

  1. Wright et al. Circumcision and the risk of prostate cancer. Cancer. 2012 Mar 12. doi: 10.1002/cncr.26653. [Epub ahead of print]
    View abstract
  2. CDC. Trends in in-hospital newborn male circumcision–United States, 1999-2010. MMWR Morb Mortal Wkly Rep. 2011 Sep 2;60(34):1167-8.
    View abstract
  3. AAP. Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics. 1999 Mar;103(3):686-93.
    View abstract
  4. Schoen, E. Ignoring evidence of circumcision benefits. Pediatrics. 2006 Jul;118(1):385-7.
    View abstract
  5. Szabo et al. How does male circumcision protect against HIV infection? BMJ. 2000 Jun 10;320(7249):1592-4.
    View abstract
  6. Circumcision may reduce prostate cancer risk. Fred Hutchinson Cancer Research Center. 2012 Mar 12.
About the Author

Kirstin Hendrickson, Ph.D., is a science journalist and faculty in the Department of Chemistry and Biochemistry at Arizona State University. She has a PhD in Chemistry, and studied mechanisms of damage to DNA during her graduate career. Kirstin also holds degrees in Zoology and Psychology. Currently, both in her teaching and in her writing, she’s interested in methods of communicating about science, and in the reciprocal relationship between science and society. She has written a textbook called Chemistry In The World, which focuses on the ways in which chemistry affects everyday life, and the ways in which humans affect each other and the environment through chemistry.

Comments

  1. Interesting. It is still not enough for me to make that decision for my son, though.

  2. Here is a partial list of conditions, behaviors, and diseases physicians have claimed over the years circumcision will prevent or cure: asthma, bladder inflammation, blindness, cancer of the cervix, cancer of the penis, cancer of the prostate, clubfoot, clumsiness, compulsion to rape, constant crying, convulsions, criminal behavior, deafness, diabetes, diarrhea, divorce, dumbness, epilepsy, excessive saliva, frequent urination, gangrene, gonorrhea, hernia, herpes, HIV/AIDS, hives, homosexuality, idiocy, impotence, indigestion, irritability, marital unhappiness, masturbation, mental disease, nervousness, nightmares, nose picking, oversensitive penis, paralysis, passion, promiscuity, restlessness, urine retention, sexual appetite, spinal curvature, swollen feet, syphilis, tuberculosis, urinary tract infections, and wet dreams.

    Are these all honest mistakes, or the biggest medical fraud in history perpetrated by circumcised men with a compulsion to have done to others what was done to them? For more information see http://www.circumcision.org.

  3. Mark Lyndon says:

    Other studies (eg Kaplan, Gibson, McCredie, Jackson, Wynder) have found no link between prostate cancer and circumcision.

  4. Tom Tobin says:

    Let me get this straight. We don’t know what causes it. But circumcision is the answer.
    This is a story we’ve been hearing since 1870. The disease changes, but the cure remains the same.
    As for relying on Schoen, how can one take him seriously, after he wrote the poem “Ode to Circumcision”. How impartial do you think he’s going to be?
    Genital cutting a baby, to maybe, possibly, prevent a disease of old men which is typically so slow growing that it is not detected until autopsy, does not seem like a good deal to me.
    In fact, it sounds downright appalling to take a knife to a healthy baby, over weak science.

  5. Mike Collin says:

    It seems the anti-circ activists love to promote the idea tha circumcision is dangerous and useless. Well is it? First, if we lived in a perfect world
    withought harmful viruses etc.and if body parts such as a foreskin never caused a person any problems, then maybe we could consider circumcision harmfull
    and useless. Sorry but its not a perfect world. Viruses such as HIV,Herpes and HPV all have an easier time entering the inner surface of the foreskin
    either through small tears in the lining or because of the immune response from such cells as Langerhan. Unfortunately an immune response to a virus such as
    HIV and Herpes is pretty much the same as the Trojan horse, and once its in its there to stay.

    Large number of studies show each of these viruses to be more common in the uncircumcised. Circumcision is not a cure all but it is considered
    by many to be a preventive measure. Yes condoms provides protection from these viruses, but you are living in a fantasy world if you think for one second
    that people always use them.

    Have you ever checked into unplanned pregnancies for example, especially among young people, I think this speakes for itself.

    From day one after an infant is circumcised, benefits start. UTI’s are less frequent for the first year of life, phimosis, paraphimosis, balanitis, thrush,
    cancer, frenulum tears (which can be very painful involving a lot of blood ) can all be either reduced or eliminated for a lifetime. As for ceanliness,
    well, thats a no brainer.

    Smegma, and fermented urine can form under the foreskin within a couple hours especially if small amounts of urine get trapped and start mixing with oils
    and shedded skin. Many reports describe the smell as repulsive.

    If anything can be done to help give someone and better defence against any these problems then maybe it should be considered more and parents should start
    requesting it more often.

  6. The study is a classic example of lying with statistics, the kind known as “data mining”. Torture the data and it will confess to anything. There was only the most borderline correlation between being non-circumcised and prostate cancer, so men circumcised in adulthood (who were non-significantly more likely to have prostate cancer – could adult circumcision cause prostate cancer? Don’t ask) were added in to push the significance over the border. Most of those extra men would have spent most of their adulthood circumcised, so it was described as “after their first sexual intercourse” as though one act of intercourse with an intact penis somehow magically sets prostate cancer in train, decades later.

    There’s one flaw with the “plausible mechanism” of infection and inflammation – the men with prostate cancer didn’t report any more than the men without. So roll up “unreported and asymptomatic infections” and other dodgy statistics claiming a connection between circumcision and STDs. This is like discussing the shade of pink of invisible elephants.

    Then an absolute reduction of 2.7% doesn’t sound like very much, so express it as a relative reduction of 15%. (Same with the “up to 60%” of HIV.)

    In the real world, even if this study is correct, it would take scores of circumcisions wasted to prevent one case of prostate cancer. In any case, the usual treatment for prostate cancer is watchful waiting, because it usually strikes so late in life that more men die with it than of it, and the life expectancy of men who die of prostate cancer is greater than that of those who don’t!

    At least penile cancer occurs somewhere near the site of circumcision. Prostate cancer strikes 20cm upstream. At this rate it won’t be long before science proves that circumcision protects against breast cancer!

  7. Mike Collin:
    “if body parts such as a foreskin never caused a person any problems” That’s a high standard to meet. There ARE no such parts, but we don’t consider for a moment cutting any other parts off.

    The Langehan hypothesis was made up on the basis of some in vitro studies, by some of the same peoplle who have been determined to push circumcision for any reason or none. Langhans cells are all over the body, not just the foreskin. They’re also plentiful on the vaginal walls. What are you going to do about that?

    Sure you can list diseases till the cows come home, but without some numbers they mean nothing. Thousands of circumcisions wasted to prevent (perhaps) one penile cancer, hundreds (perhaps) for one UTI, scores (perhaps) for one prostate cancer.

    I can list risks of circumcision, too
    aesthetic damage
    – skin-bridges
    – skin-tags
    – scarring
    – unevenness
    – excessive skin removed
    phimosis
    hairy shaft
    haemorrhage
    meatal stenosis, meatal ulcer
    de-gloving
    urethrocutaneous fistula
    infection
    – MRSA
    – hepatitis
    – tetanus
    – bladder infections
    – septic arthritis
    neuroma
    blockage of the urethra
    buried penis
    penoscrotal webbing
    deformity
    necrotising fasciitis (galloping gangrene)
    priapism
    gastric rupture
    oxygen deprivation
    clamp injuries/plastibell ring injuries
    loss of glans
    ablation (removal) of the penis
    death – from
    – haemorrhage
    – infection
    – anaesthesia

    Though each of those is rare, at 1.2 million circumcisions in the USA a year, one every 26 seconds, that’s still a substantial number. A Richmond VA pediatrician reports having to surgically revise 1600 circumcisions by other doctors in three years, suggesting a 13% complication rate,

    The scandal is that we don’t even have a good figure for the number of circumcision deaths.

    “As for ceanliness,well, thats a no brainer.” You’re right. Washing is a no-brainer. Smegma, by the way is Greek for soap, and women have smegma too. What are you going to cut off them?

  8. mike collin says:

    Circumcision Reduces HIV Infections 76% in South Africa, Researchers Find

    By Simeon Bennett – Jul 20, 2011 11:30
    Bloomberg.com

    A circumcision program in a South African township reduced the rate of new HIV infections among men
    who had the procedure by 76 percent, according to the first data to show the effect of
    circumcision in the nationwith the most AIDS cases.

    More than 20,000 circumcisions were performed between 2007 and 2010 in Orange Farm, near Johannesburg,
    according to findings presented at an AIDS conference in Rome today. The percentage of circumcised men
    from 15 to 49 years of age increased to 49 percent from 16 percent in the period, said Bertran Auvert,
    a public-health professor at the University of Versailles outside of Paris, who presented the results.

    Today’s findings are the first evidence that circumcision is altering the course of the world’s deadliest
    infectious disease in the nation hit hardest by it. Botswana, Kenya, Swaziland, Tanzania and Zimbabwe
    are among 14 African countries promoting the procedure in an effort to expand the proportion of
    circumcised men in Africa to 80 percent from about 66 percent now, said Auvert.

  9. Gregory Boyle, PhD, DSc says:

    Flawed African Studies into Male Circumcision and HIV Sexual Transmission

    Ref: Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011;19:316-334.

    http://www.salem-news.com/articles/december112011/circumcision-hiv-rg.php

    The Journal of Law and Medicine (an ERA A-ranked journal) has published a new critique of those three randomised clinical trials from Africa that purported to find that male circumcision reduces female-to-male sexual transmission of HIV by 60 percent.

    This critique provides a detailed documentation of numerous flaws in the execution of these studies and shows that the actual (absolute) reduction in HIV transmission was only 1.3 percent, not the misleadingly and frequently touted 60 percent (relative figure only). The 1.3 percent is not considered to be clinically significant.

    This is offset (in a parallel Ugandan RCT trial–Wawer et al., 2009) by a 61 percent relative INCREASE (6 percent absolute INCREASE) in male-to-female HIV transmission when the male partner was circumcised. It was reported that “Circumcision of HIV-infected men did NOT reduce HIV transmission to female partners…Condom use after male circumcision is essential for HIV prevention” (p. 229). Alarmingly, it appears that some women were NOT informed that their male partners were HIV positive (p. 230) and 17 women became infected with HIV during the trial despite their partners getting circumcised (p. 229). This trial was stopped prematurely (before the results became statistically significant) because of its “futility”.

    About half the new HIV infections in the African trials were caused through non-sexual transmission, including unsafe skin-piercing cosmetic and medical procedures, and contaminated blood exposures. Blaming the epidemic on heterosexual activity and promoting genital mutilation is a serious mistake that can only exacerbate the HIV epidemic.

    On the evidence disclosed in the published African RCT reports, these contrived studies should NOT be used in the formulation of public health policy. There is now a growing number of published critiques showing these studies to be invalid.

    http://www.circumcision.org/hiv.htm

  10. @Tom Tobin, please be aware that Schoen is not the one who did the studies to which he refers, so the question of his impartiality is not a relevant one. He merely rounded up quite a lot of scientific evidence into one place. There are scores of studies demonstrated reduced risks of various diseases/health issues with circumcision; the below is merely a partial list:

    Reduced risk of HIV:

    Auvert et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. Epub 2005 Oct 25.

    Bailey et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-56.

    Gray et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-66.

    Moses et al. The association between lack of male circumcision and risk for HIV infection: a review of the epidemiological data. Sex Transm Dis. 1994 Jul-Aug;21(4):201-10.

    Szabo et al. How does male circumcision protect against HIV infection? BMJ. 2000 Jun 10;320(7249):1592-4.

    Weiss et al. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS. 2000 Oct 20;14(15):2361-70.

    Reduced risk of HPV:

    Castellsagué et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002 Apr 11;346(15):1105-12.

    Gray et al. Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: a randomized trial in Rakai, Uganda. J Infect Dis. 2010 May 15;201(10):1455-62.

    Tobian et al. Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis. N Engl J Med. 2009 Mar 26;360(13):1298-309.

    Wawer et al. Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. Lancet. 2011 Jan 15;377(9761):209-18. Epub 2011 Jan 6.

    Reduced risk of penile cancer:

    Maden et al. History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer. J Natl Cancer Inst. 1993 Jan 6;85(1):19-24.

    Tseng et al. Risk Factors for Penile Cancer: Results of a Population-based Case–Control study in Los Angeles County (United States). Cancer Causes Control. 2001 Apr;12(3):267-77.

    • olivierpascal says:

      The foreskin is quite a unique case. So much money and time has been spent studying the possible benefits of removing this normal, healthy and functional part to try to medically justify religious and cultural circumcising traditions. Even with all those efforts, the claimed benefits still remain controversial (http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf). At the same time, almost no money and time (if any) has been spent on studying the possible long-term urological, sexual and psychological complications.