April 11, 2002

Male Circumcision Is Found to Reduce Cervical Cancer

By DENISE GRADY

Circumcising men may significantly reduce the rate of cervical cancer in women by decreasing
the spread of a sexually transmitted virus that causes nearly all cases of cervical cancer,
researchers are reporting.

A study being published today in The New England Journal of Medicine provides important
scientific evidence for a link that scientists have long suspected.

The new findings are based on 1,913 couples in five countries, including 977 couples in which the
woman had cervical cancer and 936 couples without cancer. Researchers found that circumcision
made a difference if the man had had six or more sex partners, which made him more likely to have
contracted the cancer-causing human papilloma virus, or H.P.V.
In those couples, the risk of cervical cancer was more than double if the man was not circumcised.

The findings may not apply to couples in which the man has had fewer than six sex partners,
because he is less likely to be carrying H.P.V.

The researchers say uncircumcised men may be more likely than others to contract H.P.V. because
the lining of the foreskin is especially vulnerable to the virus. Their study, which used DNA testing to
look for penile H.P.V. infection in the men, found that uncircumcised men were about three times as
likely as circumcised men to be infected.

Of the 1,913 men in the study, 1,215 had had six or more partners and 1,543 were not
circumcised.

The researchers, led by Dr. Xavier Castellsague of the Llobregat Hospital in Barcelona, used data
from seven studies in Brazil, Spain, Thailand, Colombia and the Philippines.

H.P.V. is common, and 20 million Americans are thought to be infected. The virus has about 100
strains, including 30 that are sexually transmitted. Not all the strains can cause cervical cancer, and
even when women contract a strain that does, most eliminate the virus from their bodies without
developing cancer. Some doctors recommend condoms to prevent H.P.V., but others say they may
not work as well for this virus as they do for other infections.

In the United States, there are about 13,000 cases of cervical cancer a year and 4,100 deaths.
Doctors often say it is a disease that no woman should die of. It is easily cured if detected early by
a Pap test, and the death rate in North America has declined in the past decade.

Worldwide, there are about 466,000 cases of cervical cancer a year. Each year, 231,000 women
die of the disease, mostly in developing countries, and in some of those countries the death rate is
not declining.

An editorial in The New England Journal of Medicine noted that worldwide, 25 percent of all men
are circumcised. It also said that in the United States in the 1970's about 80 percent of all newborn
boys were circumcised, but that the rate had dropped since then because medical groups like the
American Academy of Pediatrics said the procedure did not have enough benefits to recommend its
routine use.

Dr. Dimitrios Trichopoulos, a professor of cancer prevention and epidemiology at the Harvard
School of Public Health and a coauthor of the editorial, said the new study provided a medical
argument for circumcision. Dr. Trichopoulos said that on the strength of the study, if he had a
newborn son he would have him circumcised. If the global circumcision rate could be increased to
about 75 percent, he said, it could lead to a 23 percent to 43 percent drop in the incidence of
cervical cancer.

But Dr. Trichopoulos said he doubted that such a rate would ever be reached, because of costs
and other factors. "This is an area where you have political and religious sensitivities," he said.

Dr. Carol L. Brown, a gynecologic oncologist and expert on cervical cancer at Memorial
Sloan-Kettering Cancer Center in Manhattan, said that a study like the one being reported today
should be done in this country before doctors considered making recommendations about
circumcision in the United States.

"This data is good, but we have different populations," Dr. Brown said, adding that H.P.V. strains
may differ, that circumcision rates are relatively high and that it cannot be assumed that the findings
would be the same in the United States.
 

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