|LETTER TO THE EDITOR
|Year : 2016 | Volume
| 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 Submission||21-Feb-2016|
|Date of Acceptance||18-Apr-2016|
|Date of Web Publication||19-Jul-2016|
Dr. Christoph Kupferschmid
Center for Pediatrics and Adolescent Medicine, Olgastraße 85, D-89073 Ulm
Source of Support: None, Conflict of Interest: None
|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: https://www.ajandrology.com/text.asp?2016/18/6/949/182816 - DOI: 10.4103/1008-682X.182816
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. The issue is old and going back to 1951. 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.,,,,,, 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, a number of about 250 MC's would be necessary to prevent one case of PC death.
| Competing Interests|| |
The author declared no competing interests.
| References|| |
Wachtel MS, Yang S, Morris BJ. Countries with high circumcision prevalence have lower prostate cancer mortality. Asian J Androl
2016; 18: 39-42.
Ravich A, Ravich RA. Prophylaxis of cancer of the prostate, cervix and penis by circumcision. N Y State J Med
1951; 51: 1519-21.
Kaplan GW, O′Connor VJ Jr. The incidence of carcinoma of the prostate in jews and gentiles (research letter). JAMA
1966; 196: 123-4.
Gibson E. Carcinoma of the prostate in jews and uncirumcised gentiles. Br J Urol
1954; 26: 227-9.
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.
Rosenblatt KA, Wicklund KG, Stanford JL. Sexual factors and the risk of prostate cancer. Am J Epidemiol
2001; 153: 1152-8.
Rotkin ID. Studies in the epidemiology of prostate cancer: expanded sampling. Cancer Treat Rep
1977; 61: 173-80.
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.
Wynder EL, Mabuchi K, Whitmore WF. Epidemiology of cancer of the prostate. Cancer
1971; 28: 344-60.
Wright JL, Lin DW, Stanford JL. Circumcision and the risk of prostate cancer. Cancer
2012; 118: 4437-43.