Paul M Fleiss, Assistant clinical professor of paediatrics, 8124 North Hillhurst Avenue, Los Angeles, CA 90027, USA
Frederick Hodges, Medical historian, PO Box 5456, Berkeley, CA 94705, USA
EDITOR,—Although Morten Frisch and colleagues have made a valuable contribution to the study of penile cancer, they mistakenly repeat the myth that neonatal circumcision renders the subject immune to penile cancer.1 The reference given for this statement is not an epidemiological study but an opinion article by the American circumcisionist Abraham L Wolbarst in 1932.2 Wolbarst invented this myth and was directly responsible for its proliferation; he based it on unverifiable anecdotes, ethnocentric stereotypes, a faulty understanding of human anatomy and physiology, a misunderstanding of the distinction between association and cause, and an unbridled missionary zeal. It was not based on valid scientific and epidemiological research.
All subsequent repetitions of this myth are traceable to Wolbarst’s article, though Wolbarst himself advocated universal neonatal circumcision principally as a preventive for epilepsy, paralysis, and masturbation. Circumcisionists such as Wolbarst do not seem to have promoted the myth because they have a genuine interest in reducing the rate of penile cancer; they have used it instead as a scare tactic to increase the rate of neonatal circumcision. It is surprising that sober scientists such as Frisch and colleagues could have relied on such a reference in their research.
Epidemiological studies disproved Wolbarst’s myth long ago. In North America the rate of penile cancer has been estimated to be 1 in 1000003—somewhat higher than the rate of 0.82 per 100000 found by Frisch and colleagues. Maden et al reported penile cancer among a fifth of elderly patients from rural areas who had been circumcised neonatally and had been born at a time when the rate of neonatal circumcision was about 20% in rural populations.4 Their study also shows that the rate of penile cancer among men circumcised neonatally has risen in the United States relative to the rise in the rate of neonatal circumcision.
Science must look beyond normal human anatomy to discover the true risk factors for penile cancer. Current investigations into risks posed by infection with human papillomavirus (circumcised males have been shown to have an increased risk of such infection) and use of tobacco have been instructive.5 Frisch and colleagues have otherwise injected a welcome note of scientific rationalism into the debate over circumcision, which, despite the active participation of medical staff, is in essence an issue not of medical science but of human rights.
- Frisch M, Friis S, Kruger Kjaer S, Melbye M. Falling incidence of penis cancer in an uncircumcised population. BMJ 1995; 311:1471. (2 December.) FREE Full Text
- Wolbarst, AL. Circumcision and penile cancer. Lancet 1932; i:150–3.
- Cutler SJ, Young JL Jr. Third national cancer survey: incidence data. Bethesda, Md, US Dept of Health, Education, and Welfare, Public Health Service, 1975.
- Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. JNCI 1993; 85:19–24.
- Cook LS, Koutsky LA, Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993; 69:262–4. Medline Web of Science