Medical Groups To Review Circumcision-Cancer Link

Patrick Goodenough | April 12, 2002 | 8:11pm EDT
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Pacific Rim Bureau ( - Pediatricians in Australia who are reviewing their policy on male circumcision will take into account new research from the U.S., which says women who have sex with uncircumcised men are at greater risk of developing cervical cancer.

This was confirmed Friday by Dr. Jill Sewell, president of the Pediatrics and Child Health Division of the Royal Australasian College of Physicians.

Sewell was invited to respond to a study published in Thursday's edition of the New England Journal of Medicine, which also found that men who are circumcised are less likely to develop the virus that is believed to be responsible for almost 99 percent of cervical cancer cases.

The study, which used data from seven separate studies in five countries, said the virus, called human papillomavirus (HPV), occurred in 19.6 percent of uncircumcised men, but in 5.5 percent of circumcised men. More than 1,900 couples of similar social and medical backgrounds from countries in Asia, Europe and South America participated.

It said women whose partners were uncircumcised were more likely to develop cervical cancer - and if the man had had multiple partners in the past, the risk was even higher.

An editorial accompanying the study in the journal called the findings "convincing," but argued that the use of condoms could also prevent transmission of the HPV virus from male to female.

Sewell said her division of the Royal Australasian College of Physicians was currently reviewing its policy on circumcision, and its policy committee would consider the new information.

Its current recommendation is that there is no medical indication for routine circumcision of male infants and no overall public health benefit. But the decision should be up to parents, who should have access to the necessary information in order to make an informed choice.

Sewell noted that the new study reinforced the message of the importance of regular pap smears for women and the practice of "safe sex."

Australia has one of the higher rates of routine male circumcision - between 10 and 15 percent - although it falls a long way behind the United States, where a figure of around 60 percent was reported in the late 1990s.

In both countries, and others, circumcision is becoming less common, with the strengthening of an anti-circumcision lobby which regards the procedure - removal of the foreskin of the penis - as barbaric and even a violation of a child's human rights.

Proponents circumcise their sons for cultural, religious or hygiene reasons. In both Australia and the U.S., surgeons' organizations hold the view that there is no medical reason for routine circumcision of young boys - or if there is a medical benefit, it is not sufficient to recommend the procedure.

In the U.S., the American Academy of Pediatrics will also consider the new information when its committee on circumcision meets next, the association's Dr. John Swanson was quoted as saying.

Its current recommendation says that any medical benefits are "not sufficient to recommend routine [newborn] circumcision."


Dr. George Williams, an Australian pediatrician and anti-circumcision campaigner, said Friday retrospective studies of this nature were fraught with methodological problems.

Ideally, subjects should be identified in advance and then followed in such a way that controlled all the variables impacting on cancer - unprotected sex, number of sexual partners, presence of HPV virus, socio-economic status, and standard of hygiene.

"This is the problem with all the studies. The foreskin gets demonized because it's presumed that the foreskin predisposes you to cancer."

Williams said he opposed circumcision because it "abuses children," exposes them to needless risks, and permanently alters the function of the penis.

The specialist heading the new study said there were several possible reasons for its findings - an circumcised penis may be easier to keep clean, for instance, or the foreskin could be more prone to harboring the HPV virus.

An additional theory was suggested by Cancer Research UK in Britain, which said that "certain religious groups who practice circumcision, such as the Jews, also have a low risk of cervical cancer due to low levels of promiscuity."

Jews and Muslims circumcise their male babies as part of religious tradition, going back some 4,000 years for Jews and 1,200 for Muslims.

In some African cultures, circumcision plays a part in manhood rituals in the mid- to late-teens.

In July 2000, a U.S. specialist caused a stir when he told an international conference in South Africa that circumcision could help prevent AIDS-HIV infection in Africans.

Robert Bailey of the University of Illinois in Chicago said more than half of all HIV infections in some groups could have been prevented had the men been circumcised. Moreover, the men would also have been less likely to infect women, he added.

Most of the millions of AIDS victims in Africa are heterosexual men and women, as well as babies who can be infected through breast milk.

Bailey's suggestion that African health workers consider whether circumcision should be promoted as part of the campaign against AIDS was criticized by anti-circumcision activists.

The emphasis should be put on promoting condom use, they said.


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