2009-01-19 UroToday - Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomav

[RobertW]

http://www.urotoday.com/index.php?option=com_content&task=view_ua&id=2219756

Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa - Abstract

Monday, 19 January 2009 Assistance Publique-Hôpitaux de Paris, University of Versailles, Institut National de la Santé et de la Recherche Médicale, Unité 687, France.
National Institute for Communicable Diseases and Progressus, Johannesburg, South Africa.
A causal association links high-risk human papillomavirus (HR-HPV) and cervical cancer, which is a major public health problem. The objective of the present study was to investigate the association between male circumcision (MC) and the prevalence of HR-HPV among young men.
We used data from a MC trial conducted in Orange Farm, South Africa, among men aged 18-24 years. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios (PRRs) were assessed using univariate and multivariate log Poisson regression.
In an intention-to-treat analysis, the prevalences of HR-HPV among the intervention and control groups were 14.8% (94/637) and 22.3% (140/627), respectively, with a PRR of 0.66 (0.51-0.86) ([Formula: see text]). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results.
This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women. Trial registration.
Written by:
Auvert B, Sobngwi-Tambekou J, Cutler E, Nieuwoudt M, Lissouba P, Puren A, Taljaard D. Are you the author? (http://www.urotoday.com/information_for/submission_guidelines/submitting_commentary.html?s_cid=invite_abstract_b tasubmit_t)
Reference:
J Infect Dis. 2009 Jan 1;199(1):14-9. (javascript:popWin('http://www.journals.uchicago.edu/doi/abs/10.1086/595566?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov?s_cid=citation', 'width=450,height=350,left=160,top=100,scrollbars= yes,resizable=yes,toolbar=no,location=no,menubar=y es,directories=no,status=no');)
doi:10.1086/595566
PubMed Abstract (javascript:popWin('http://www.ncbi.nlm.nih.gov/pubmed/19086814?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum?s_c id=pubmed','width=450,height=350,left=160,top=100, scrollbars=yes,resizable=yes,toolbar=no,location=n o,menubar=yes,directories=no,status=no');)
PMID:19086814
UroToday.com Sexually Transmitted Disease Section (http://www.urotoday.com/browse_categories/sexually_transmitted_disease/1199/?s_cid=invite_abstract_std_t)

http://www.urotoday.com/images/stories/logo_urotoday_sm.jpg (http://www.urotoday.com/3341/browse_categories/beyond_the_abstract/2528/?s_cid=invite_abstract_bta_b)

[Joseph]

Auvert is on the case.

This "study" is already suspect.

[Joseph]

What the American Cancer Society has to say:

http://www.fathermag.com/health/circ/acs/

As representatives of the American Cancer Society, we would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer. The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such cancers.

Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated, and has not been taken seriously in the medical community for decades.

Likewise, research claiming a relationship between circumcision and penile cancer is inconclusive. Penile cancer is an extremely rare condition, affecting one in 200,000 men in the United States. Penile cancer rates in countries which do not practice circumcision are lower than those found in the United States. Fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.

Portraying routine circumcision as an effective means of prevention distracts the public from the task of avoiding the behaviors proven to contribute to penile and cervical cancer: especially cigarette smoking, and unprotected sexual relations with multiple partners. Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.

Sincerely,

(signed)
Hugh Shingleton, M.D.
National Vice President Detection & Treatment

(signed)
Clark W. Heath, Jr., M.D.
Vice President Epidemiology & Surveillance Research

[greg_b]

Thanks for following this and the links Joseph! It is great to have these types of rebuttels.

Cheers!

[RobertW]

I agree, thanks for the rebuttal! I did not want to believe it and took it with a grain of salt. It just seems like bad news about foreskin comes at us like water through a leaky earthen dam. Plug up one hole with facts and another hole opens up. It's wearying. Joseph you are tireless, thank goodness.

[Joseph]

No, sometimes I feel like giving up altogether... Sometimes I don't know what keeps me going...

At any rate, there is an interesting analisys at circumstitions.com you should check out.

http://circumstitions.com/Cancer.html#cervical
Scroll down just a little and you'll find this same study, however, there are other HPV studies on there.


Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa
Bertran Auvert, Joelle Sobngwi-Tambekou, Ewalde Cutler, Marthi Nieuwoudt, Pascale Lissouba, Adrian Puren and Dirk Taljaard

Background. A causal association links high-risk human papillomavirus (HR-HPV) and cervical cancer, which is a major public health problem. The objective of the present study was to investigate the association between male circumcision (MC) and the prevalence of HR-HPV among young men.

Methods. We used data from a MC trial conducted in Orange Farm, South Africa, among men aged 18–24 years. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. [Neilson et al. found that the penile shafts of circumcised men were only very marginlly less likely to carry HPV than those of intact men. Aguilar et al. found that urethral swab samples were less than half as likely to give a positive result as penile shaft samples. ] Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios (PRRs) were assessed using univariate and multivariate log Poisson regression.

Results. In an intention-to-treat analysis, the prevalences of HR-HPV among the intervention and control groups were 14.8% (94/637) and 22.3% (140/627), respectively, with a PRR of 0.66 (0.51– 0.86) (P
.002). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results. [What? Circumcision made a difference but condom use didn't? How is that possible? Something is very wrong here.]

Conclusions. This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women. [And Auvert's reference for this claim is an article by arch-circumcisionist Brian Morris in a molecular medicine journal (his official specialty) extolling circumcision for every purpose imaginable. Morris's references for the claim is the Castellsagué study above and a study by Halperin, Bailey, et al. of the rates in different developing countries, that does not actually establish correlation between individuals, only populations.]