Abstract
The recent policy statement by the Cancer Council of Australia on infant circumcision and cancer prevention and the announcement that the quadrivalent human papillomavirus (HPV) vaccine will be made available for boys in Australia prompted us to provide an assessment of genital cancer prevention. While HPV vaccination of boys should help reduce anal cancer in homosexual men and cervical cancer in women, it will have little or no impact on penile or prostate cancer. Male circumcision can reduce cervical, penile and possibly prostate cancer. Promotion of both HPV vaccination and male circumcision will synergistically maximize genital cancer prevention.
Highlights
The Cancer Council of Australia recently issued a policy statement entitled “Neonatal male circumcision and cancer” that addresses penile cancer and prostate cancer, concluding that it “does not recommend circumcision as a routine cancer-preventive procedure at this time” (Cancer Council of Australia, 2012). This policy was based on the infant circumcision policy of the Royal Australasian College of Physicians (2010) that ignored much of the compelling evidence concerning the medical benefits of male circumcision (Morris et al, 2012a)
The American Academy of Pediatrics (2012) new policy statement and technical report concludes that the health benefits of male circumcision outweigh the risks
In the absence of a comprehensive cost-benefit analysis of male circumcision in Australia, we considered it instructive to provide preliminary, approximate calculations, which should be regarded as hypothesis generating only
Summary
The Cancer Council of Australia recently issued a policy statement entitled “Neonatal male circumcision and cancer” that addresses penile cancer and prostate cancer, concluding that it “does not recommend circumcision as a routine cancer-preventive procedure at this time” (Cancer Council of Australia, 2012). Meta-analyses have confirmed findings of previous epidemiological studies, suggesting that phimosis, balanitis and the presence of smegma increase the risk of penile cancer by 12-, 4- and 3-fold, respectively (Morris et al, 2011) Each of these risk factors is either more common in, or exclusive to, uncircumcised men. A meta-analysis of 21 observational studies and two RCTs has, shown that circumcision reduces by 43% and 33%, respectively, the risk of genital infection by high-risk HPV in men (Bosch et al, 2009). The protective effect was not affected by socioeconomic status These new findings add to numerous previous studies that have shown a 30–50% lower prevalence of prostate cancer in circumcised men (Morris et al, 2007; 2011). Be recognised that even a small reduction in prostate cancer incidence has the potential to represent enormous savings in lives and costs (Morris et al, 2007)
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