Evidence sketchy on circumcision and cervical cancer link

Dr Rivet¹ has failed to review criticism of the article² by Castellsagué et al in the New England Journal of Medicine. The article has been criticized for its poor methodology,³ because circumcision removes specific erogenous tissue^4-6 and because male and female partners have different types of human papillomavirus (HPV).⁷

Castellsagué and colleagues admit to being “puzzled” by these findings. In addition, they emphasize that they did not recommend circumcision.⁸ These comments place Castellsagué and colleagues’ findings regarding circumcision’s protective effects against cervical cancer in the dubious category.

A vaccine for HPV has been tested and found to be effective.⁹ It is probable that, by the time infants born today reach maturity, a vaccine will be available to prevent cervical cancer.

In view of the above, neonatal circumcision cannot be recommended to prevent cervical cancer. Human papillomavirus causes cervical cancer; the foreskin does not. Safer sex, not circumcision, prevents the spread of HPV.

The recent cautionary statements by three provincial colleges of physicians and surgeons regarding non-therapeutic circumcision of male children should be of greater concern to family physicians.^10-12

—George Hill
Executive Secretary, Doctors Opposing Circumcision
Seattle, Wash
by e-mail

References

1. Rivet C. Circumcision and cervical cancer. Is there a link? [Critical Appraisal]. Can Fam Physician 2003;49:1096-7.
2. Castellsagué X, Bosch X, Munoz N, Meijer C, Shah K, De Sanjosé S, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002;346:1105-12.
3. Travis JW. Male circumcision, penile human papillomavirus infection, and cervical cancer [letter]. N Engl J Med 2002;347(18):1452-3.
4. Bhimji A, Harrison D. Male circumcision, penile human papillomavirus infection, and cervical cancer [letter]. N Engl J Med 2002;347(18):1452-3..
5. Winkelmann RK. The erogenous zones: their nerve supply and its significance. Mayo Clin Proc 1959;34:39-47.
6. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5.
7. Franceschi S, Castellsagué X, Dal Maso L, Smith JS, Plummer M, Ngelangel C, et al. Prevalence and determinants of human papillomavirus genital infection in men. Br J Cancer 2002;86:705-11.
8. Castellsagué X, Bosch FA, Muñoz M. Author’s reply. N Engl J Med 2002;347(18):1448.
9. Koutsky LA, Ault KA, Wheeler CM. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med 2002;347:1645-51.
10. Kendel DA. Caution against routine circumcision of newborn male infants (Memorandum to physicians and surgeons of Saskatchewan). Saskatoon, Sask: College of Physicians and Surgeons of Saskatchewan; February 20, 2002.
11. College of Physicians and Surgeons of British Columbia. Infant male circumcision. College Q 2002;Fall:2.
12. College of Physicians and Surgeons of Manitoba. Caution regarding routine circumcision of newborn male infants. Newsletter 2002;38(Dec):4.

[CIRP Note: The original of this document is located at: http://www.cfpc.ca/cfp/2003/Dec/vol49-dec-letters-4.asp.]