Evidence sketchy on circumcision and cervical cancer link

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

Arif Bhimji, MD; Dennis Harrison, BSC

Dr Christine Rivet¹ presents evidence suggesting that circumcision reduces risk of human papillomavirus (HPV) infection in men and cervical cancer in their female partners.

This evidence should be put in perspective. Other studies have found no significant correlation between circumcision and either HPV or cervical cancer.^2,3 Moreover, a large and well controlled American study found that circumcised men were likely than uncircumcised men to have had both bacterial and viral sexually transmitted diseases. Moreover, a large and well controlled American study found that circumcised men were slightly more likely than uncircumcised men to have had both bacterial and viral sexually transmitted diseases.⁴ For chlamydia, one of the most common sexually transmitted diseases, the difference between circumcised men and uncircumcised men was quite large. While 26 of 1033 circumcised men had contracted chlamydia during their lives, none of the 353 intact men reported having had it.

Evidence linking the foreskin to sexually transmitted infections and cervical cancer is contradictory. But even if the evidence were conclusive, it would still not constitute a justification for circumcising baby boys. Because infants are not sexually active, they should not be required to bear the burden of preventing sexually transmitted infections. Sexually transmitted diseases will be prevented by practising safer sex, not by circumcising infants. If circumcision is touted as a prophylactic, it could confer a false sense of security and encourage high-risk sexual behaviour.

Some physicians believe that infant male circumcision should be a matter of parental choice, even though the procedure is not medically indicated. However, operating on an incapable patient who has no medical need for surgery is normally viewed as a violation of medical ethics. As the College of Physicians and Surgeons of Saskatchewan noted last year in a memo to its members, performing surgery of questionable value on an infant is generally considered imprudent if not improper.

—Arif Bhimji, MD
Richmond Hill, Ont
—Dennis Harrison, BSC
Vancouver, BC
Spokespersons,
Association for Genital Integrity
by e-mail

References

Rivet C. Circumcision and cervical cancer. Is there a link? [Critical Appraisal]. Can Fam Physician 2003;49:1096-7.
Aynaud O, Piron D, Bijaoui G, Casanova JM. Developmental factors of urethral human papillomavirus lesions: correlation withcircumcision. Br J Urol Int 1999;84(1):57-60.
Terris M, Wilson F, Nelson JH Jr. Relation of circumcision to cancer of the cervix. Am J Obstet Gynecol 1973;117(8):1056-66.
Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA 1997;277(13):1052-7.

Note:

The original of this document is located at:

http://www.cfpc.ca/cfp/2003/Dec/vol49-dec-letters-4.asp.

Citation:

Bhimji A, Harrison D. Evidence sketchy on circumcision and cervical cancer link. Can Fam Physician. 2003-12;49:1591.

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