Cancer of the Penis

American physician Abraham Wolbarst was also responsible for promoting the erroneous notion that circumcised men were immune to cancer of the penis. His opinion piece published in the Lancet in 1932[120] − a time when the causes of cancer were not understood − has been erroneously cited as fact ever since.

It was not long, however, before doctors started to report cases of cancer in circumcised men.[121] Maden et al. studied a population of 110 men with penile cancer, and found that 41 cases were in circumcised men.[122] Despite these cases, the researchers claimed that not being circumcised was a risk factor for penile cancer.[122] However, when Maden’s data were properly adjusted for age, there was no difference in the risk for circumcised and non-circumcised men.[123]

Two subsequent case-control studies found that being diagnosed with pathological phimosis was an important risk factor for penile cancer.[16,119] When the data were controlled for phimosis, not having been circumcised as an infant was not a significant risk factor. Other risk factors include genital warts/HPV infection, tobacco use, and an increased number of lifetime sex partners.[122,124,125]

DNA from human papillomavirus (HPV, which is contracted by sexual contact) has been identified in penile cancer cells in about half the cases of penile cancer, so these infections are an important risk factor.[125,126] Half of penile cancers may be linked to balanitis xerotica obliterans (BXO), which is increasingly being identified as a precancerous condition, and whose cause is not fully understood.[12,127,128]

Based on numbers provided in the 2012 American Academy of Pediatrics Circumcision Task Force report,[5] the number of circumcisions needed to prevent one case of penile cancer is between 4237 and 7184. With the average reimbursement for infant circumcision being $285 paid at the time of the procedure,[53] the cost at the time of the procedure would be between $1.21 million and $2.01 million. But this is not the true cost, because the opportunity costs of not having the money available for the 80 years before penile cancer usually occurs has not been considered. Typically the opportunity costs are between 3% and 5% per annum. With this taken into account, using circumcision to prevent one case of penile cancer would cost between $12.85 million and $101.47 million.

Cancer of the penis is a rare disease of elderly men (occurring in the U.S. in less than 1 in 100,000 men,[129] with an average age of diagnosis of 68 years[130]). Breast cancer is actually more common in men than cancer of the penis.[131]) To prevent penile cancer, the American Cancer Society does not recommend circumcision for all males, rather it recommends avoiding exposure to HPV and HIV, not smoking, and good genital hygiene.[132]

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References

5. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130(3):e756-85.
12. Edwards SK, Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014;25(9):615-626.
16. Dunn HP. Non-surgical management of phimosis. Aust N Z J Surg. 1989;59(12):963.
53. Hart-Cooper GD, Tao G, Stock JA, Hoover KW. Circumcision of privately insured males aged 0 to 18 years in the United States. Pediatrics. 2014;134:950-6.
120. Wolbarst A. Circumcision and penile cancer. Lancet. 1932;1(5655):150-3.
121. Boczko S, Freed S. Penile carcinoma in circumcised males. N Y State J Med. 1979;79(12):1903-4.
122. Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst. 1993;85(1):19-24.
123. Cold CR, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76-year-old circumcised man. J Fam Pract. 1997;44:407-10.
124. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, et al. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer. 2005;116:606-16.
125. Harish K, Ravi R. The role of tobacco in penile carcinoma. Br J Urol. 1995;75(3):375-7.
126. McCance DJ, Kalache A, Ashdown K, Andrade L, Menezes F, Smith P, et al. Human papillomavirus types 16 and 18 in carcinomas of the penis from Brazil. Int J Cancer. 1986;37(1):55-9.
127. Jamieson NV, Bullock KN, Barker TH. Adenosquamous carcinoma of the penis associated with balanitis xerotica obliterans. Br J Urol. 1986;58:730-1.
128. Powell J, Robson A, Cranston D, Wojnarowska F, Turner R. High incidence of lichen sclerosus in patients with squamous cell carcinoma of the penis. Br J Dermatol. 2000;145:85-9.
129. What are the key statistics about penile cancer? American Cancer Society website. Last revised 2016 Feb 9.
130. What are the risk factors for penile cancer? American Cancer Society website. Last revised 2016 Feb 9.
131. What are the key statistics about breast cancer in men? American Cancer Society website. Last revised 2016 Jan 26.
132. Can penile cancer be prevented? American Cancer Society website. Last revised 2016 Feb 9.

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