History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer

University of Washington Seattle, Seattle, Washington, United States
JNCI Journal of the National Cancer Institute (Impact Factor: 12.58). 02/1993; 85(1):19-24. DOI: 10.1093/jnci/85.1.19
Source: PubMed


Epidemiological evidence suggests lack of neonatal circumcision as the strongest risk factor for penile cancer, but the role of sexually transmitted diseases in the etiology of penile cancer has remained unclear.
To further clarify risk factors for penile cancer, we examined the role of circumcision, personal characteristics and habits (such as smoking), sexually transmitted diseases, past sexual activity, and medical conditions of the penis.
A population-based, case-control study was conducted in western Washington state and in the province of British Columbia. We interviewed 110 men with penile cancer diagnosed from January 1979 to July 1990 and 355 control subjects from the general population, frequency matched to case subjects on age and date of diagnosis. Tumor tissue from 67 case subjects was tested for human papillomavirus (HPV) DNA by polymerase chain reaction. Results of blood tests from 69 case subjects and 208 control subjects were available for study. STATISTICALLY SIGNIFICANT RESULTS: Relative to men circumcised at birth, the risk for penile cancer was 3.2 times greater among men who were never circumcised and 3.0 times greater among men who were circumcised after the neonatal period. For current smokers, the risk was 2.8 times that of men who never smoked. The risk among men reporting a history of genital warts was 5.9 times that of men reporting no such history. Of 67 tumors tested for HPV DNA, 49% were positive; the majority of these positive tumors (70%) were type 16, which has been associated with anogenital carcinoma. Relative risks (RRs) associated with a reported history of penile rash or penile tear were 9.4 and 3.9, respectively. Among men not circumcised at birth, RRs associated with presence of smegma and difficulty in retracting the foreskin were 2.1 and 3.5, respectively. Twenty-eight percent of case subjects, compared with only 10% of control subjects, reported 30 or more sexual partners, and men with HPV-positive tumors were more likely to report a greater number of sexual partners.
These results suggest that the absence of neonatal circumcision and potential resulting complications are associated with penile cancer. Additionally, medical conditions of the penis, sexual activity, infection with HPV, and smoking may increase the risk for penile cancer.
A larger study would allow examination of interrelationships of circumcision, infection with HPV, and smoking as risk factors.

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    • "However, the studies cannot be aggregated in their results as different methods have been used to obtain values for incidence and prevalence. As has been previously noted, infant circumcision has been posited to have a protective role in penile cancer (Maden et al. 1993; Larke et al. 2011; Pizzocaro et al. 2010). The rates of infant circumcision are widely different between Australia and the UK, which have broadly similar populations. "
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    ABSTRACT: To investigate and compare the trends in incidence and mortality of penile cancer between Australia, England and Wales, and the US, and provide hypotheses for these trends. Cancer registry data from 1982 to 2005 inclusive were obtained from Australia, England and Wales, and the United States. From these data, age-specific, -standardised and mortality:incidence ratios were calculated, and compared. The overall incidence of penile cancer in England and Wales (1.44 per 100,000 man-years) was higher than in Australia (0.80 per 100,000), and the US (0.66 per 100,000). Incidence of penile cancer in all three countries has remained relatively stable over time. Similarly, although the mortality rates were also higher in England and Wales (0.37 per 100,000 man-years) compared to Australia (0.18 per 100,000) and the US (0.15 per 100,000), the mortality/incidence ratios were similar for all three countries. Penile cancer incidence is low, affecting mainly older men. Rates differ between the three countries, being twice as common in England and Wales as in the other studied regions. Circumcision rates have a potential influence on these rates but are not the sole explanation for the variation.
    Full-text · Article · Aug 2015 · SpringerPlus
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    • "Delayed circumcision may not be protective because men who are circumcised later in life often undergo the procedure as treatment for phimosis or an existing chronic inflammatory condition. Other risk factors for penile cancer include current smoking (Daling et al., 2005; Hellberg et al., 1987; Maden et al., 1993; Tsen et al., 2001), early age at first sexual intercourse (Madsen et al., 2008), high lifetime number of female sexual partners (Daling et al., 2005; Maden et al., 1993; Madsen et al., 2008), lack of condom use (Madsen et al., 2008), chronic inflammatory conditions including balantitis and lichen sclerosus (Daling et al., 2005; Nasca et al., 1999), and treatment with ultraviolet photochemotherapy for psoriasis (Stern, 1990). "
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    ABSTRACT: Human papillomavirus (HPV) is highly prevalent in men and there is an interest in further understanding the relationship between HPV infection and disease in men, including the development of genital warts, penile intraepithelial neoplasia and invasive penile carcinomas. Genital warts are caused by HPV 6/11 and are the most common clinical manifestation of HPV in men. Though they are benign and not associated with mortality, they are a source of psychosocial distress and physical discomfort. HPV infection can also develop into invasive penile carcinoma which is associated with morbidity and mortality. Approximately 40% of invasive penile carcinomas are attributable to HPV with HPV 16, 18, and 6/11 being the genotypes most commonly detected in penile tumors. Penile carcinomas of the basaloid and warty histologic subtypes are most likely to test positive for HPV. In addition to HPV infection, the risk factors most strongly associated with penile cancer are lack of neonatal circumcision, phimosis (the inability of uncircumcised men to fully retract the foreskin), and anogenital warts. Male vaccination with the quadrivalent HPV vaccine that protects against HPV 6/11/16/18 has been shown to significantly reduce HPV-associated anogenital infection and disease in men. If the quadrivalent vaccine is successfully disseminated to large segments of the young male population, there is the potential for substantial reduction in genital HPV infection and related lesions in men.
    Full-text · Article · Oct 2011 · Preventive Medicine
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    • "The presence of an intact foreskin has been identified as an important risk factor for developing penile cancer. Maden et al. [5] found that the risk of penile cancer was 3.2-times greater among men who had never been circumcised relative to men circumcised at birth and 3.0-times greater among men circumcised after the neonatal period [3, 5]. In addition, penile cancer is rarely seen in Jews, as they are circumcised at birth [3]. "
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    ABSTRACT: Penile cancer is an uncommon malignancy that has a devastating effect on the patient while also being challenging to diagnose and treat. By implementing preventive measures, we can decrease the incidence of this disease and improve the quality of life of our patients. Early detection plays an important role in disease control and proper diagnostic modalities must be used in order to accurately identify the cancer and its progression. Primary penile lesions should be initially approached when surgically feasible and clinically appropriate with penile preserving surgical techniques. Advances in inguinal lymph node detection and management, has improved the clinical outcome of penile cancer. Advanced penile cancer still portends a poor prognosis and should be approached via a multimodal treatment regimen. In this review, we address the importance of prevention, early detection, and the contemporary management of primary penile lesions, as well as the advances in inguinal lymph node disease detection and surgical treatment, for both localized and advanced disease.
    Full-text · Article · May 2011 · Advances in Urology
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