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Cory Silverberg

Maybe Another Reason to Maybe Get Circumcised. Maybe.

By March 13, 2012

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This week an article published in the journal Cancer documents a possible connection between being circumcised and having a lower risk of prostate cancer. Possible, as always, is the key word here.

The study compared data from 1,754 men who were diagnosed with prostate cancer and compared them with about the same number of men who do not have prostate cancer. The researchers interviewed both groups of men in-person and asked them questions about a variety of things including whether or not they were circumcised, the age at which they were circumcised, and the age at which they first engaged in "sexual intercourse" (the paper doesn't say whether they specified penile-vaginal intercourse, but they do report that about 2.5% of the total sample had male sexual partners).

They found that men who were circumcised before they first had sexual intercourse were 15 percent less likely to develop prostate cancer than uncircumcised men.

They note that this is only an observation. There is no way of knowing what role, if any, being circumcised had in this 15% difference. Still, they went looking for this based on the theory that infections, including sexually transmitted infections, increase the risk of getting prostate cancer and the theory that being circumcised reduces one's risk of getting a sexually transmitted infections. If these theories are all correct, then they propose it follows that circumcision would offer protection against prostate cancer.

It's a lot of theories to string together, and as the authors make clear this is just the beginning. Many questions remain. Aside from whether or not it's possible to isolate a factor like circumcision from all other factors in order to say that it confers this or that benefit in disease prevention, I'm curious about how to square this research with the findings that adult male circumcision is protective against HIV. That research remains controversial, and other studies have produced other findings, but it's interesting to think about how we talk and think about circumcision when we are mostly talking about treatment of brown people in Africa as opposed to how we think about it when we are talking about white people in North America.

It's not that there aren't plenty of African American men with prostate cancer. Actually they have the highest rates of prostate cancer. But they are also more than twice as likely than their white counterparts to die from prostate cancer, a health disparity which speaks to just who prevention and treatment in North America is geared to (here's a hint: it's the people who can pay for it).

All of this leaves me only more confused about what to think of circumcision as a health intervention and about how exactly to help parents who are trying to make decisions about circumcision based on the available evidence.

Read More: MSNBC.com: Circumcision Tied to Lower Prostate Cancer Risk

Previously - San Francisco Votes on Circumcision Ban ; Research Insights from the Male Circumcision-HIV Protection Trials ; Is Mass Circumcision a Good Idea?

Source:
Wright, J.L., Lin, D.W. & Stanford, J.L. "Circumcision and the Risk of Prostate Cancer" Cancer. Published online March 12, 2012.

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Comments
March 14, 2012 at 1:29 am
(1) Ladyfingers says:

The problem with all the research done on circumcision in America is that it is never compared to the rates outside of America. Rates of all STDs and urological complaints are lower in the rest of the developed world despite circumcision barely existing outside America.

It is simply not done in other secular nations, because the vast majority of men outside of America have no problem with their foreskins (quite the converse) and would not consider amputating part of their sons’ genitalia.

Perhaps they have better sex education and therefore better condom use. Maybe that’s where the focus should move in public health instead of forcing surgery on newborn males. Condoms for a 95-99% improvement in sexual health, or surgery for a moot improvement.

The old aphorism about a man with a hammer seeing nails everywhere is never more apt than on this topic.

March 14, 2012 at 6:49 pm
(2) Jeff Wanston says:

I wish my parents had circumcised me as a child. First off, sweat gathers beneath my foreskin and it creates a nasty odor (even when clean, I would never ask a woman to perform oral sex on me). It’s also kind of a hassle to wash in there because I have to pull it back to expose the area, this is not easily done when flaccid.

I always regretted being different from all the other kids in my gym class and after-sports locker rooms and showers. One bully had cruel nicknames for me. It was embarrassing.

The worst part is that I’ve had a few sexual experiences where women were really turned-off by my appearance, one girl couldn’t “go forward”.

There is no question in my mind that if I have a son, I want to have him circumcised.

Anyway, thanks for the article Cory!

March 15, 2012 at 4:06 am
(3) Hugh7 says:

“They found that men who were circumcised before they first had sexual intercourse were 15 percent less likely to develop prostate cancer than uncircumcised men.”
This is not true. It should read “…than uncircumcised men pooled with men circumcised after they’d had sexual intercourse.” Without those men (who were non-significantly MORE likely to get prostate cancer. Their results wouldn’t reach significance at all. As it is, their statistical significance is marginal. Even if the 15% was rock-solid (sorry, puns are inevitable), that’s 39 circumcisions wasted for every one that prevents a cancer. Circumcision itself is riskier than that. (A Richmond VA pediatrician had to repair 1600 circumcisions by other doctors in three years, suggesting a complication rate of 13%)

@Jeff Wanston: if you hate your normal, whole genitals that much, there is a solution available to you. Need I spell it out? Jumping a generation won’t help you, and your son may hate being circumcised just as much as you hate being whole. Such men greatly outnumber you.

March 15, 2012 at 10:35 am
(4) Cazador says:

The results were NOT statistically significant, so what are they talking about? Circumcision causes lifelong physical, sexual, and often psychological damage. Why are American doctors promoting genital mutilation?

March 30, 2012 at 7:18 pm
(5) Ac says:

Correlation ≠ causation. But you know that. =)

April 9, 2012 at 2:42 pm
(6) Ladyjade says:

When in doubt, leave it alone. I think the burden of proof is on the side of circumcision. If there is no convincing evidence that it is of any real, significant benefit that can’t be achieved through less drastic means, why and how is this an agonizing decision? Its not a decision at all. Leave the boy alone and let him decide later what he wants. It can always be done later. It’s not a now or never deal, just leave it alone and don’t ever forcibly retract it and cause problems where there aren’t any.

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