Risk factors for anal cancer: results of a population-based case–control study

Tseng, Hung Fu; Morgenstern, Hal; Mack, Thomas M.; Peters, Ruth

doi:10.1023/b:caco.0000003837.10664.7f

Cited by 145 publications

(197 citation statements)

References 21 publications

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“…In this study, we observed an increased risk for invasive (OR 5 2.3), but not in situ, penile cancer (OR 5 1.1) among men not circumcised in childhood, consistent with the findings of Tseng et al 5 Here and in other studies, 2,5,12,13 a history of phimosis was a strong risk factor for penile cancer. Interestingly, though it was a risk factor for both invasive and in situ disease, the proportions of subjects with invasive and in situ penile cancer who reported a history of phimosis (47% and 21%, respectively) were different (v 2 p for difference 5 0.02).…”

Section: Discussionsupporting

confidence: 91%

“…Potential risk factors are compared to biologic markers of HPV exposure through testing of pathologic specimens for HPV DNA in cases and testing for serum HPV16 antibodies in both cases and controls. Because circumcision status has been shown to modify the risk of penile cancer in previous studies, 2,5 circumcision status and the timing of the procedure are given special attention.…”

mentioning

confidence: 99%

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Penile cancer: Importance of circumcision, human papillomavirus and smoking in in situ and invasive disease

Daling

Madeleine

Johnson

et al. 2005

Intl Journal of Cancer

408

326

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Few population-based case-control studies have assessed etiologic factors for penile cancer. Past infection with high-risk human papillomavirus (HPV) is a known risk factor for penile cancer; however, few previous studies have related the HPV DNA status of the tumor to potential demographic and behavioral risk factors for the disease or evaluated whether in situ and invasive penile cancer share risk factors. Little information is available on the role and timing of circumcision in the etiology of penile cancer. We conducted a population-based case-control study in western Washington state that included 137 men diagnosed with in situ (n 5 75) or invasive (n 5 62) penile cancer between January 1, 1979, and December 31, 1998, and 671 control men identified through random digit dialing. Cases and controls were interviewed in person and provided peripheral blood samples. Case and control blood samples were tested for antibodies to HPV16 and HSV-2, and tumor specimens from cases were tested for HPV DNA. Men not circumcised during childhood were at increased risk of invasive (OR 5 2.3, 95% CI 1.3-4.1) but not in situ (OR 5 1.1, 95% CI 0.6-1.8) penile cancer. Approximately 35% of men with penile cancer who had not been circumcised in childhood reported a history of phimosis compared to 7.6% of controls (OR 5 7.4, 95% CI 3.7-15.0). Penile conditions such as tear, rash and injury were associated with increased risk of disease. Among men not circumcised in childhood, phimosis was strongly associated with development of invasive penile cancer (OR 5 11.4, 95% CI 5.0-25.9). When we restricted our analysis to men who did not have phimosis, the risk of invasive penile cancer associated with not having been circumcised in childhood was not elevated (OR 5 0.5, 95% CI 0.1-2.5). Cigarette smoking was associated with a 4.5-fold risk (95% CI 2.0-10.1) of invasive penile cancer. HPV DNA was detected in 79.8% of tumor specimens, and 69.1% of tumors were HPV16-positive. The proportion of HPV DNA-positive tumors did not vary by any risk factors evaluated. Many risk factors were common for both in situ and invasive disease. However, 3 factors that did not increase the risk for in situ cancer proved significant risk factors for invasive penile cancer: lack of circumcision during childhood, phimosis and cigarette smoking. The high percentage of HPV DNA-positive tumors in our study is consistent with a strong association between HPV infection and the development of penile cancer regardless of circumcision status. Circumcision in early childhood may help prevent penile cancer by eliminating phimosis, a significant risk factor for the disease. ' 2005 Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Penile cancer: Importance of circumcision, human papillomavirus and smoking in in situ and invasive disease

Daling

Madeleine

Johnson

et al. 2005

Intl Journal of Cancer

408

326

View full text Add to dashboard Cite

show abstract

“…119,120 These studies show an association between circumcision and a decreased likelihood of invasive penile cancer. For all men with penile cancer (carcinoma in situ and squamous cell carcinoma), the absence of circumcision confers an increased risk with an odds ratio (OR) of 1.5, although this finding was not significant (P = .07), with a CI of 1.1-2.2.…”

Section: Cancer Penile Cancermentioning

confidence: 94%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

299

149

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Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

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“…Systematic reviews show that circumcised men are at significantly lower risk of syphilis and chancroid. 8,9 Circumcised men in the United States are also at significantly lower risk of invasive penile cancer, [10][11][12][13] and a lower risk of cervical cancer in partners of circumcised men has also been reported. 14 This may be due to decreased human papillomavirus infection, which causes ano-genital and cervical cancer.…”

Section: Non-hiv-related Benefits To Women Of Male Circumcisionmentioning

confidence: 99%