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Male circumcision and penile cancer: a systematic review and meta-analysis.

Larke NL, Thomas SL, dos Santos Silva I, Weiss HA - Cancer Causes Control (2011)

Bottom Line: Random effects meta-analyses were used to calculate summary odds ratios (ORs) and 95% confidence intervals (CI).In two studies, the protective effect of childhood/adolescent circumcision on invasive cancer no longer persisted when analyses were restricted to boys with no history of phimosis.Men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer, and this effect could be mediated partly through an effect on phimosis.

View Article: PubMed Central - PubMed

Affiliation: MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Natasha.larke@lshtm.ac.uk

ABSTRACT

Objective: We systematically reviewed the evidence of an association between male circumcision and penile cancer.

Methods: Databases were searched using keywords and text terms for the epidemiology of penile cancer. Random effects meta-analyses were used to calculate summary odds ratios (ORs) and 95% confidence intervals (CI).

Results: We identified eight papers which evaluated the association of circumcision with penile cancer, of which seven were case-control studies. There was a strong protective effect of childhood/adolescent circumcision on invasive penile cancer (OR = 0.33; 95% CI 0.13-0.83; 3 studies). In two studies, the protective effect of childhood/adolescent circumcision on invasive cancer no longer persisted when analyses were restricted to boys with no history of phimosis. In contrast, there was some evidence that circumcision in adulthood was associated with an increased risk of invasive penile cancer (summary OR = 2.71; 95% CI 0.93-7.94; 3 studies). There was little evidence for an association of penile intra-epithelial neoplasia and in situ penile cancer with circumcision performed at any age.

Conclusions: Men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer, and this effect could be mediated partly through an effect on phimosis. Expansion of circumcision services in sub-Saharan Africa as an HIV prevention strategy may additionally reduce penile cancer risk.

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Association of male circumcision and invasive penile carcinoma: random effects meta-analysis
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Fig3: Association of male circumcision and invasive penile carcinoma: random effects meta-analysis

Mentions: Nine analyses from six papers evaluated the effect of circumcision on invasive penile cancer [14, 23, 24, 27, 28, 32]; (Table 1; Fig. 1). Three of the four analyses of circumcision in childhood/adolescence, used a comparison group of never circumcised men. The overall OR from these three analyses showed strong evidence of a protective effect (summary OR = 0.33; 95% CI 0.13–0.83) (Fig. 3). There was some evidence of heterogeneity in estimates (p-heterogeneity = 0.11; I2 = 55%) although all three studies showed a protective rather than detrimental effect. The sensitivity analysis including only the two analyses that adjusted for covariates showed little evidence of heterogeneity (summary OR = 0.50; 95% CI 0.29–0.86; p-heterogeneity = 0.69; I2 = 0.0%; n = 2).Fig. 3


Male circumcision and penile cancer: a systematic review and meta-analysis.

Larke NL, Thomas SL, dos Santos Silva I, Weiss HA - Cancer Causes Control (2011)

Association of male circumcision and invasive penile carcinoma: random effects meta-analysis
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139859&req=5

Fig3: Association of male circumcision and invasive penile carcinoma: random effects meta-analysis
Mentions: Nine analyses from six papers evaluated the effect of circumcision on invasive penile cancer [14, 23, 24, 27, 28, 32]; (Table 1; Fig. 1). Three of the four analyses of circumcision in childhood/adolescence, used a comparison group of never circumcised men. The overall OR from these three analyses showed strong evidence of a protective effect (summary OR = 0.33; 95% CI 0.13–0.83) (Fig. 3). There was some evidence of heterogeneity in estimates (p-heterogeneity = 0.11; I2 = 55%) although all three studies showed a protective rather than detrimental effect. The sensitivity analysis including only the two analyses that adjusted for covariates showed little evidence of heterogeneity (summary OR = 0.50; 95% CI 0.29–0.86; p-heterogeneity = 0.69; I2 = 0.0%; n = 2).Fig. 3

Bottom Line: Random effects meta-analyses were used to calculate summary odds ratios (ORs) and 95% confidence intervals (CI).In two studies, the protective effect of childhood/adolescent circumcision on invasive cancer no longer persisted when analyses were restricted to boys with no history of phimosis.Men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer, and this effect could be mediated partly through an effect on phimosis.

View Article: PubMed Central - PubMed

Affiliation: MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Natasha.larke@lshtm.ac.uk

ABSTRACT

Objective: We systematically reviewed the evidence of an association between male circumcision and penile cancer.

Methods: Databases were searched using keywords and text terms for the epidemiology of penile cancer. Random effects meta-analyses were used to calculate summary odds ratios (ORs) and 95% confidence intervals (CI).

Results: We identified eight papers which evaluated the association of circumcision with penile cancer, of which seven were case-control studies. There was a strong protective effect of childhood/adolescent circumcision on invasive penile cancer (OR = 0.33; 95% CI 0.13-0.83; 3 studies). In two studies, the protective effect of childhood/adolescent circumcision on invasive cancer no longer persisted when analyses were restricted to boys with no history of phimosis. In contrast, there was some evidence that circumcision in adulthood was associated with an increased risk of invasive penile cancer (summary OR = 2.71; 95% CI 0.93-7.94; 3 studies). There was little evidence for an association of penile intra-epithelial neoplasia and in situ penile cancer with circumcision performed at any age.

Conclusions: Men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer, and this effect could be mediated partly through an effect on phimosis. Expansion of circumcision services in sub-Saharan Africa as an HIV prevention strategy may additionally reduce penile cancer risk.

Show MeSH
Related in: MedlinePlus