Circumcision and Cancer of the Cervix

Abstract

THE relative infrequency of cancer of the uterine cervix in Jewish women compared with women of other races has interested epidemiologists since the beginning of the century, but has not yet been explained. The average annual number of cases per 100,000 Jewish women in Israel over a 19-year period has been shown by Hochman, Ratzkowski and Schreiber (1955) to be 2-2, while the rate per 100,000 women elsewhere ranges from 17 in Sweden to 44 in a group of 10 cities in the U.S.A. Reasons for the disparity have been sought in genetics, in the Jewish ritual laws governing sexual hygiene and in the possible protective effects of universal male circumcision. Support for the circumcision hypothesis is found in the lower frequency of cancer of the cervix in other populations who practise circumcision when compared with populations who do not. Again, penile cancer is rare in those circumcised at an early age, suggesting some carcinogenic property of smegma and an association between poor penile hygiene and cancer of the cervix. It is not easy to isolate the effect of circumcision from that of many simultaneous variables and environmental differences between population groups. Circumcision has been included among the factors considered in several careful studies of the aetiology of this disease, but its importance is still in doubt. The difficulty in finding out if there is a lower rate of cancer of the cervix among wives of circumcised non-Jewish men lies in ascertaining accurately who is or is not effectively circumcised, and in obtaining the information for all of the sexual partners of each woman. While the second difficulty seems insurmountable, the present study attempts to compare, by physical examination in 110 cases, the circumcision status of present husbands of women with pre-cinical and clinically diagnosed cancer of the cervix and husbands of matched controls. Even such a small number is of interest when the facts about circumcision are definitely established. Moreover, the study has shown what degree of co-operation can be obtained in such an inquiry and what error there would be were examination dispensed with and the husband's or wife's report relied on. PREVIOUS WORKIn population groups other than Jewish, practising circumcision, lower rates of cervical cancer have been noted when compared with groups in the same general environment who do not practise circumcision. Examples have come from the 10

Prevalence Rates of Uterine Cervical Carcinoma in situ for Women Using the Diaphragm or Contraceptive Oral Steroids

“…In several different studies a lower rate of cervical carcinoma was found for women who had used barrier contraceptives (diaphragm or condom), compared with women using no contraceptive (Terris and Oalmann, 1960;Boyd and Doll, 1964;Aitken-Swan and Baird, 1965). Though not confirmed by all investigators (Lombard and Potter, 1950 ;Wynder et al, 1954;Jones et al, 1958;Rotkin and King, 1962), this finding, if true, could well account for the differences we found.…”

Prevalence Rates of Uterine Cervical Carcinoma in Situ for Women Using the Diaphragm or Contraceptive Oral Steroids

“…In several different studies a lower rate of cervical carcinoma was found for women who had used barrier contraceptives (diaphragm or condom), compared with women using no contraceptive (Terris and Oalmann, 1960;Boyd and Doll, 1964;Aitken-Swan and Baird, 1965). Though not confirmed by all investigators (Lombard and Potter, 1950 ;Wynder et al, 1954;Jones et al, 1958;Rotkin and King, 1962), this finding, if true, could well account for the differences we found.…”

Herpes genitalis and circumcision.

“…Melamed, Koss, Flehinger, Kelisky, and Dubrow (1969) found a significantly increased prevalence of carcinoma of the cervix in patients using oral contraceptives compared with those using a diaphragm, while Terris and Oalmann (1960), Boyd andDoll (1964), andAitken-Swan andBaird (1965) found that patients using barrier methods had a lower incidence of carcinoma of the cervix than those using no contraceptives. This finding was not confirmed by Winder and others (1954) and Rotkin and King (1962).…”

“…However, Dodge, Linsell, and Davies (1963) in East Africa found no relationship between the tribal distribution of carcinoma of the cervix and the practice of circumcision among tribal males. Aitken-Swan and Baird (1965) and Terris, Wilson, and Nelson (1973) found no positive association between circumcision status and cervical carcinoma. The role of both HSV and circumcision is therefore still uncertain in the aetiology of carcinoma of the cervix.…”