BRITISH MEDICAL JOURNAL, (London) Vol. 312 no 7033 (March
23, 1996): pp. 779-780


Editor, - Although Morten Frisch and colleagues have made a
valuable contribution to the study of penile cancer, they
mistakenly repeat the myth that neonatal circumcision
renders the subject immune to penile cancer.[1]  The
reference given for this statement is not an epidemiological
study but an opinion article by the American circumcisionist
Abraham L. Wolbarst in 1932.[2]  Wolbarst invented this myth
and was directly responsible for its proliferation; he based
it on unverifiable anecdotes, ethnocentric stereotypes, a
faulty understanding of human anatomy and physiology, a
misunderstanding of the distinction between association and
cause, and a unbridled missionary zeal.  It was not based on
valid scientific and epidemiological research.

          All subsequent repetions of this myth are
traceable to Wolbarst's article, though Wolbarst himself
advocated universal neonatal circumcision principally as a
preventive for epilepsy, paralysis, and masturbation.
Circumcisionists such as Wolbarst do not seem to have
promoted this myth because they have a genuine interest in
reducing penile cancer; they used it instead as a scare
tactic to increase the rate of neonatal circumcision.  It is
surprising that sober scientists such as Frisch and
colleagues could have relied on such a reference in their

          Edidemiological studies disproved Wolbarst's myth
long ago.  In North America the rate of penile cancer has
been estimated to be 1 in 100,000[3] - somewhat higher than
the rate of 0.82 per 100,000 found by Frisch and colleagues.
 Maden et al reported penile cancer among a fifth of elderly
patients from rural areas who had been circumcised
neonatally and had been born at a time when the rate of
neonatal circumcision was about 20% in rural populations.[4]
 Their study also shows that the rate of penile cancer among
men circumcised neonatally has risen in the United States
relative to the rise in the rate of neonatal circumcision.

          Science must look beyond normal human anatomy to
discover the true risk factors for penile cancer.  Current
investigations into risks posed by infection with human
papillomavirus (circumcised males have been shown to have an
increased rate of such infection) and use of tobacco have
been instructive.[5]  Frisch and his colleagues have
otherwise injected a welcome note of scientific rationalism
into the debate over circumcision, which, despite the active
participation of medical staff, is in essence an issue not
of medical science but of human rights.

                                              PAUL M FLEISS
                 Assistant clinical professor of pediatrics

8124 North Hillhurst Avenue
Los Angeles, CA  90027

                                           FREDERICK HODGES
                                          Medical Historian

PO Box 5456
Berkeley, CA  94507

1.Frisch M, Friis S, Kruger Kjaer S, Melbye M. Falling
incidence of penis cancer in an uncircumcised population.
BMJ 1995; 311:1471 (2 December.)

2. Wolbarst, AL. Circumcision and penile cancer. Lancet
1932; 150-3.

3. Cutler SJ, Young JL Jr.  Third national cancer survey:
incidence data.  Bethesda, Md.  US Dept of Health,
Education, and Welfare, Public Health Service, 1975

4. Maden C, Sherman KJ, Beckman AM, Hislop TG, Teh CZ,
Ashley RL, et al. History of circumcision, medical
conditions, and sexual activity and risk of penile cancer.
JNCI 1993;85:19-24

5. Cook LS, Koutsky LA, Holmes KK. Clinical presentation of
genital warts among circumcised and uncircumcised
heterosexual men attending an urban STD clinic.  Genitourin
Med 1993;69:262-4