The Link between Circumcision and lower risk of Penile Cancer

Circumcision helps to lower the risk of men developing prostate cancer. (Section is still work in progress)

Summaries of Research Results

Trends in penile cancer: a comparative study between Australia, England and Wales, and the US.

Sewell J, Ranasinghe W et. al., Springerplus. 2015 Aug 14;4:420. doi: 10.1186/s40064-015-1191-4. eCollection 2015.

PURPOSE: To investigate and compare the trends in incidence and mortality of penile cancer between Australia, England and Wales, and the US, and provide hypotheses for these trends.
METHODS: Cancer registry data from 1982 to 2005 inclusive were obtained from Australia, England and Wales, and the United States. From these data, age-specific, -standardised and mortality:incidence ratios were calculated, and compared.
RESULTS: The overall incidence of penile cancer in England and Wales (1.44 per 100,000 man-years) was higher than in Australia (0.80 per 100,000), and the US (0.66 per 100,000). Incidence of penile cancer in all three countries has remained relatively stable over time. Similarly, although the mortality rates were also higher in England and Wales (0.37 per 100,000 man-years) compared to Australia (0.18 per 100,000) and the US (0.15 per 100,000), the mortality/incidence ratios were similar for all three countries.
CONCLUSIONS: Penile cancer incidence is low, affecting mainly older men. Rates differ between the three countries, being twice as common in England and Wales as in the other studied regions. Circumcision rates have a potential influence on these rates but are not the sole explanation for the variation.
For the online abstract, see here.

Comment: while the findings in this study suggest declines in male circumcision in the UK, and to a lesser extend in Australia, may explain rises in penile cancer, the authors predict that given the lag between declining infant circumcision prevalence and disease onset later in life this correlation, "would be likely to begin to be observed in 2020 and trend upwards until 2060." It should also be noted that the authors present annual incidence figures. Over the lifetime approximately 1 in 1,000 uncircumcised males (and hardly any circumcised males) will develop penile cancer. Thus penile cancer is uncommon, but certainly not rare.

A urologist's contemporary guide to penile cancer.

Jakobsen JK., Scand J Urol. 2015 Aug 14:1-6.

Few urologists deal with penile cancer on a daily basis. Owing to the rarity of the disease and its diversity in presentation, clinical experience accumulates slowly and new paradigms spread sporadically. This review provides a concise update on the background, clinical features and multidisciplinary management strategies of penile cancer. The evidence base of penile cancer management recommendations is devoid of randomized controlled trials and relies mainly on retrospective cohort studies from single institutions. In recent years, international multicentre collaboration has increased the quality of evidence. Larger study cohorts allow researchers to engage in subgroup analysis of patients with poor prognosis, of which the literature so far has been scarce. Comprehensive evidence-based guidelines are available through the European Association of Urology. This review highlights the importance of early and minimally invasive regional lymph-node staging of all patients of stage T1G2 or higher, and underlines the therapeutic potential of inguinal lymph-node dissection in lymph-node positive patients. A discussion of the oncological safety of current trends towards more phallus-sparing treatment techniques emphasizes the importance of proper case selection, thorough patient information, consequent follow-up and the possibility of a reconstructive procedure after organ-sparing ablative penile surgery. The aetiological role of human papilloma virus (HPV) is touched upon and the evidence for circumcision and HPV vaccination of boys is briefly weighed. The value of multidisciplinary treatment of advanced penile cancer is underlined and the role of chemotherapy, radiotherapy and radiochemotherapy is discussed. Finally, the perspectives for hybrid tracer sentinel node, robot-assisted lymph-node surgery and targeted therapies are addressed.

It should be noted that penile cancer is rare in circumcised men, but affects 1 in 1,000 uncircumcised men over their lifetime.