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Year : 2016  |  Volume : 18  |  Issue : 6  |  Page : 949

Commentary on "Countries with high circumcision prevalence have lower prostate cancer mortality"

Center for Pediatrics and Adolescent Medicine, Olgastraße 85, D-89073 Ulm, Germany

Date of Submission21-Feb-2016
Date of Acceptance18-Apr-2016
Date of Web Publication19-Jul-2016

Correspondence Address:
Dr. Christoph Kupferschmid
Center for Pediatrics and Adolescent Medicine, Olgastraße 85, D-89073 Ulm
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1008-682X.182816

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How to cite this article:
Kupferschmid C. Commentary on "Countries with high circumcision prevalence have lower prostate cancer mortality". Asian J Androl 2016;18:949

How to cite this URL:
Kupferschmid C. Commentary on "Countries with high circumcision prevalence have lower prostate cancer mortality". Asian J Androl [serial online] 2016 [cited 2021 Aug 1];18:949. Available from: - DOI: 10.4103/1008-682X.182816

Dear Editor,

I have read with interest and some amazement the article of Dr. Wachtel and coworkers describing a hypothetical benefit of male circumcision (MC) on prostatic cancer (PC) mortality rates.[1] The issue is old and going back to 1951.[2] Unfortunately, the authors have omitted the literature during the last 65 years which was not able to prove that MC would protect against PC mortality.[3],[4],[5],[6],[7],[8],[9] Wachtel and coworkers draw their study data from different heterogeneous sources and different years without testing if they describe items of comparable population groups.

Most strikingly, the results of the paper do neither support the headline of the article nor support the conclusions. The MC-rates in Europe and Southeast Asia are far lower than in the United States. The authors, however, found lower PC mortality in Europe and Southeast Asia when compared to the United States (OR 0.6 and 0.42). It is hard to understand how this can lead to the conclusion that "thus, prostate cancer mortality is significantly lower in countries in which MC prevalence exceeds 80%." Especially as PC mortality in the Eastern Mediterranean countries and Sub-Saharan region with MC rates >80% clearly exceed the European rates with an MC prevalence below 20%.

The evaluation of PC mortality compared to MC prevalence shows that PC is similar from 0 to 80% MC but lower in the 80%-100% MC group. It should at least be discussed which protective factor would not be effective until 80% but would have a significant effect above this level. The more likely explanation is that the databases describe populations and countries with medical, hygienic, and social differences which have a greater influence on PC mortality than has MC.

According to the results of Wright and coworkers,[10] a number of about 250 MC's would be necessary to prevent one case of PC death.

  Competing Interests Top

The author declared no competing interests.

  References Top

Wachtel MS, Yang S, Morris BJ. Countries with high circumcision prevalence have lower prostate cancer mortality. Asian J Androl 2016; 18: 39-42.  Back to cited text no. 1
Ravich A, Ravich RA. Prophylaxis of cancer of the prostate, cervix and penis by circumcision. N Y State J Med 1951; 51: 1519-21.  Back to cited text no. 2
Kaplan GW, O′Connor VJ Jr. The incidence of carcinoma of the prostate in jews and gentiles (research letter). JAMA 1966; 196: 123-4.  Back to cited text no. 3
Gibson E. Carcinoma of the prostate in jews and uncirumcised gentiles. Br J Urol 1954; 26: 227-9.  Back to cited text no. 4
Lai FC, Kennedy WA, Lindert KA, Terris MK. Effect of circumcision on prostatic bacterial colonization and subsequent bacterial seeding following transrectal ultrasound-guided prostate biopsies. Tech Urol 2001; 7: 305-9.  Back to cited text no. 5
Rosenblatt KA, Wicklund KG, Stanford JL. Sexual factors and the risk of prostate cancer. Am J Epidemiol 2001; 153: 1152-8.  Back to cited text no. 6
Rotkin ID. Studies in the epidemiology of prostate cancer: expanded sampling. Cancer Treat Rep 1977; 61: 173-80.  Back to cited text no. 7
Jackson MA, Kovi J, Heshmat MY, Ogunmuyiwa TA, Jones GW, et al. Characterization of prostatic carcinoma among blacks: a comparison between a low-incidence area, Ibadan, Nigeria, and a high-incidence area, Washington, DC. Prostate 1980; 1: 185-205.  Back to cited text no. 8
Wynder EL, Mabuchi K, Whitmore WF. Epidemiology of cancer of the prostate. Cancer 1971; 28: 344-60.  Back to cited text no. 9
Wright JL, Lin DW, Stanford JL. Circumcision and the risk of prostate cancer. Cancer 2012; 118: 4437-43.  Back to cited text no. 10


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