Evidence sketchy on circumcision and cervical cancer link

Canadian Family Physician, Volume 49: Page 1591, December 2003.

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 tissue4-6 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.

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

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