PHILADELPHIA: Prostate protection claim refuted by four experts [edited June 5]

Circumcision again shown to have no benefit, despite researchers' best efforts to spin the data

MyFoxPhilly
May 29, 2014

Lower risk of prostate cancer seen in circumcised blacks

[Yes and green jelly beans cause acne.]
by Randy Dotinga
THURSDAY, May 29, 2014 (HealthDay News) -- A new study on prostate cancer suggests that circumcision might have a preventive effect in black men and men who undergo the procedure later in life.

The findings are preliminary, and they don't suggest circumcision lowers the risk of prostate cancer for most men. Nor are experts recommending the procedure as a cancer-preventive strategy.

Still, "it may be that circumcision should be considered as an option for men at higher risk, such as black men and men with a family history of prostate cancer, but we need more research to confirm this," said study co-author Marie-Elise Parent. She is an associate professor of epidemiology at the University of Quebec's INRS-Institut Armand-Frappier Research Center in Laval, Canada.

Prostate cancer is the second-leading cause of cancer death in U.S. men, behind only lung cancer, according to the American Cancer Society. About one in seven men will be diagnosed with the disease in his lifetime [and one in three have been found to have it on autopsy], and prostate cancer will kill one in 36, the cancer society estimates.

"We still know very little about the potential causes of prostate cancer. There are probably many factors associated with it, but so far we have not been able to pin down what factors could be modified in order to prevent this cancer," Parent said. [Um, smoking?]

"All that we know for sure is that risk of developing it increases with age, that having a father, brother or son with prostate cancer increases one's risk, and that this cancer is more frequent among men of African ancestry," Parent added.

There's no way to use these risk factors to prevent the disease, she said.

Previous research has suggested that circumcision could slightly reduce the risk of prostate cancer, Parent said. Circumcision has also been linked to lower rates of sexually transmitted diseases like HIV, the virus that causes AIDS. However, circumcision remains controversial, with critics calling it barbaric, unnecessary and an impediment to sexual pleasure.

In the new study, published May 29 in the journal BJU International, researchers examined the medical records of 1,555 men treated for prostate cancer at a Montreal hospital from 2005-09. They compared them to 1,586 similar men who didn't have prostate cancer.

The researchers couldn't find a statistically significant difference in prostate cancer rates between circumcised and uncircumcised men.

However, the researchers did find a 60 percent lower risk of prostate cancer among circumcised black men. They also found evidence linking circumcision after age 35 to a 45 percent lower risk of prostate cancer.

But the findings merely point to an association between circumcision and lower risk in these two groups, not a direct cause-and-effect relationship.

The researchers reached their conclusions after adjusting their statistics for traits such as age at diagnosis and family history of prostate cancer. Due to the design of the study, researchers cannot offer simple numbers to describe the levels of risk for various types of men.

Parent cautioned that the black men in the study, mainly of French descent, may not reflect black men as a whole. And she said the study included few men who were circumcised at a later age, so that finding is potentially questionable.

Dr. Stephen Freedland, a urologist and associate professor of surgery and pathology at the Duke University School of Medicine in Durham, N.C., pointed out that men circumcised after age 35 are unusual. "They're usually older guys who are sick and have medical problems," he said.

The study findings as a whole aren't convincing, Freedland added, especially since it included relatively few black men -- just 178 of more than 3,100 participants.

"I don't think we'll be recommending massive circumcisions to prevent prostate cancer," he said. [He may not, but Brian Morris and others, predictibly, have.] "And men shouldn't go around thinking, 'I'm circumcised, therefore I'm safe from prostate cancer.'"

If circumcision does have a protective effect against prostate cancer -- and that's not proven -- why would that be so?

Circumcision at an early age may possibly protect against later sexually transmitted infections, which are thought to increase the risk of prostate cancer, Parent said. [But studies such as the Dickson cohort study found no such protection.]

"We tried to take this into consideration into our study," she said. "It did not seem to be the main explanatory factor, but it cannot be ruled out entirely, either."

---

New York Daily News
June 2, 2014

Chemo, circumcision could affect prostate cancer rates

by Meredith Engel
...
"We've known for a long time that circumcision has definite health benefits," Dr. Baskies continued. "Circumcision decreases the chances of HPV infection, the development of cancer of the penis, and now it appears it decreases the risk of the development of prostate cancer." ["But wait! There's more!..."]

But not all doctors are convinced of this study's merit.

"Even with the study, the official medical stance is still that there's no medical evidence to suggest that routine circumcision is a medically prudent intervention," said Dr. James McKiernan, interim chair of urology at NewYork-Presbyerian/Columbia University Medical Center.

Dr. McKiernan noted that the study's results are not significant enough to warrant change, and that the study subjects are "an unusual subgroup of people."

"I don't think the quality of the data is there to change practice," he said.
Previous research has found that circumcision also ...

---

Sense About Science
April 8, 2014

"Circumcision cuts risk of prostate cancer by 45%"

... Dr Matthew Hobbs, Deputy Director of Research at Prostate Cancer UK responded to the study saying:

“Although this study appears to show that circumcision after the age of 35 could reduce your risk of prostate cancer, the evidence presented is nowhere near strong enough that men should begin to consider circumcision as a way to prevent the disease. While the total sample studied was large, the number of men who had been circumcised after the age of 35 was very small, so this should not be seen as strong evidence of an association. There was no statistically significant association between prostate cancer and circumcision for men circumcised at all other ages. No reason was collected for circumcision, so we can’t say if the association is with circumcision later in life or with whatever causes men to have circumcisions after that age. It is also highly likely that diet, lifestyle, socioeconomic status and healthcare behaviours may have played a role in skewing these results.”

---

Philly.com
June 3, 2014

Circumcision Linked To Lowered Prostate Cancer Risk

by Krystnell Storr, Reuters
... Dr. Christopher Cooper, a professor and urologist at the University of Iowa told Reuters Health that the Canadian study does not justify promoting circumcision as prostate cancer prevention
The number of black men studied was too small for any conclusions to be drawn, he notes. Only 103 of the participants with prostate cancer were black men, and only 75 of the healthy men in the comparison group were black.

"The STD mechanism is possible but quite a stretch," Cooper said. He also pointed out that there were certain factors the researchers could not control in the study, such as how honest participants were about having STDs or, among the men circumcised as adults, the reason for their circumcision.
Parent told Reuters Health that even though the study was small, and she and her colleagues saw only a slightly reduced risk later in life among men who were circumcised as babies, the work is one more thing to consider when studying prostate cancer.

"We are too early in the game to make it a public recommendation. It could be that in the future it will be confirmed that it's a good thing and may have an added protection from other diseases," she added. [She virtually admits that this is advocacy research.]

SYDNEY: "Any cut or nick ... amounts to mutilation" - Judge

"Any cut or nick ... will amount to mutilation"

News.com (Sydney)
May 24, 2014

Sydney sheik, mum and nurse to face mutilation judgment

A SYDNEY mother stood in the dock holding her baby daughter as she became the first person in the state to be committed to stand trial for genital mutilation.

The mother, who can’t be named, and retired nurse Kubra Magennis became the first people in NSW to stand trial for female genital mutilation, accused in Parramatta Local Court yesterday of performing the circumcision ritual on the mother’s daughters, aged 6 and 7. The pair face a maximum sentence of seven years in jail if convicted.

Sheik Shabbir Vaziri is charged with being an accessory to the circumcision ritual, allegedly telling locals to lie to police about the prevalence of female genital mutilation in the community.

The alleged circumcisions took place in Wollongong and Sydney some time between October 2010 and July 2012.

Defence lawyers unsuccessfully tried to argue the girls were not victims of female genital mutilation because they only received a nick to their clitoris.

Magistrate Roger Brown dismissed the submission, saying: “Any cut or nick to the clitoris will amount to mutilation.”
...

The prosecution will largely rely on a police interview and a phone intercept between the mother and Ms Magennis.
...

The girls’ father, a GP, and four other female relatives, who can’t be named to protect the girls, were also charged over the circumcision but their charges were dismissed at earlier court appearances.

A lawyer has been committed to stand trial with perverting the course of justice over the ritual circumcisions.

A date for the trial of Sheik Vaziri, Ms Magennis and the girls’ mother will be set on June 20.

Earlier story

ZIMBABWE: Child circumcision ignites debate

Common sense breaks out....

Bulawayo24 (Zimbabwe)
May 25, 2014

Child circumcision ignites debate

Zimbabweans have expressed mixed feelings over an on-going male circumcision campaign, especially that which targets children.

Zimbabwe introduced ["voluntary"] medical male circumcision in 2009 following studies indicating that the procedure reduces chances of contracting HIV by 60 percent.

More than 40 local members of parliament volunteered to be circumcised in a campaign targeting 1,2 million males by 2015.

Population Services International, a US-based global health agency, is offering the testing and circumcision procedures.

There are others who believe the 2009 medical male circumcision campaigns being churned out through the media were misleading as they try to portray circumcised men as "confident, outgoing, sexually appealing, and set to succeed in life."

Raymond Majongwe, a National Aids Council, Nac board member said the media campaigns on male circumcision were mischievous in that they give a false sense of security to those who would have gone under the knife.

"They then think they are macho and can go on bedding girls. It is like a licence to be promiscuous.
"I also do not believe in those said ‘celebrities' that are being used to promote the idea. Stunner for example, is another male circumcision ambassador who after being circumcised went on to shoot a sex video that went viral, exposing his circumcised manhood," hit Majongwe at a recent gathering in Chinhoyi.

Stunner underwent circumcision in 2011 before he and Pokello recorded themselves having sex and the images later found their way on Internet and multimedia, first via Facebook and later circulated via WhatsApp.

Majongwe said it was puzzling that while God created man with the fore skin, there are others who now believe it has to be removed.

"God created us that way," said Majongwe adding that he has always been skeptical of the on-going male circumcision campaigns.

Dr. Karin Hatzold, deputy head of Population Services International (PSI) Zimbabwe, said her organisation is using entertainers to persuade young men to get circumcised.

"We have campaigns that are specifically targeting adolescents, people in schools — so during school holidays we are doing massive mobilisations on mass media... "So get smart, get circumcised. Male circumcision is not only HIV prevention intervention, but it is improving hygiene, you are cleaner, you are smarter.'"

Matobo senator Sithembile Mlotshwa once touched off a storm when she called on the ministry of Health and Child Care to stop circumcising children under the 2009 medical male circumcision programme.

In media reports, Mlotshwa was quoted as saying: "In our constitution, everyone is born with a right to life and I think it is wrong for a father and mother to sit down and decide to circumcise this young child who is a month old whereas the father was circumcised at the age of 40.

"This circumcised man's parents gave him all these years to mature and know the uses of all the organs of his body so as to decide how best to remake what is God-given.

"So then why does this person want to agree with his wife to circumcise an infant who is a third person who has a right to be fully developed as he is so that he makes his own decisions about his body organs?"

Mlotshwa believes children should be allowed to make their own choices when they grow up instead of being circumcised under this programme funded by international donors.

"I want to take our minister of Health to task because I believe that you don't have to circumcise infants."

Celebrated writer Virginia Phiri said the fact is that circumcision of males has always been there. "That is either for religious or traditional beliefs and at times for medical conditions."

...

"As this procedure is not easily reversible or it can be expensive to do, so these sons will have to live with the situation that they will find themselves in," she said.

...

Legislator Jessie Fungayi Majome said it is a sad or happy (depending on the circumstances) fact of life that children are bundled with the fate and decisions of their parents.

"To cut or not to cut must be decided according to which of the two is in the best interests of the child as required in our new Constitution.

"I think more research must be done to give objective knowledge of the pros and cons of male circumcision.

"Any circumcision campaign must still and concurrently emphasise the necessity to either abstain, or be faithful or use a condom," said Majome. [Any of which makes circumcision irrelevant.]

...

Social commentator Precious Shumba ... added that from experiences of some residents, a circumcised person cannot abstain from sex, meaning there is reported increase in the demand for sex, risking infection.

Political activist Tabani Moyo said ... "... those agitating circumcision should engage in ethical advertising by outlining the dangers that come with the process so that when people decide to do it, they do so with all the critical information at hand.

"At the moment, there is too much high voltage advertising which borders on deceit that might end up leading to unintended consequences as the adverts seem to give an impression that your chances of getting HIV/Aids for example are reduced, this is irresponsible advertising," said Moyo.
 
...

Pan Africanist, Thomas Deve said what we know about circumcision makes us welcome it for health and religious purposes or as a rite of passage to manhood in some traditions.

"I am sceptical of the Americans pouring in money via the PSI-led initiative when they are withdrawing state-funded programmes in their own country," said Deve.

PSI's health director Louisa Norman has been quoted in the media as saying: "If we can circumcise 1,2 million men by 2015 we can prevent 750 000 new cases of HIV, which means we can really start to envision a country in which there are no new HIV infections." [These figures are based on "modelling", assuming the "60%" reduction claimed in the three trials translates exactly on to the real world - in other words, Just Made Up.]

Zimbabwe has 1,1 million people living with HIV, including 150 000 children, according to Nac.
[And more of the circumcised men have HIV than the non-circumcised:]

HOUSTON, TX: Congressman wants to protect circumcision - in Europe!

"Protecting" adults at the expense of children

Your Houston News
May 24, 2014

Stockman seeks to protect religious freedom in the European Union

In response to the growing number of religious freedom assaults in the European Union, Congressman Stockman introduced H.R. 4650, the "European Union Religious Freedom Act." It was referred to the Foreign Affairs Committee.

This bill seeks to amend the International Religious Freedom Act of 1998 to include religious freedom violations relating to homeschooling, Jewish and Islamic meat production, circumcision practices, and religious garb.

"In countries like Bulgaria and Lithuania, parents can't homeschool their children. In Sweden and Denmark, Jews and Muslims can't prepare meat according to their religious beliefs. In Sweden alone, they face legal restrictions on circumcision. In France, citizens cannot wear religious garb in public schools," said Congressman Stockman.

"These laws are unjust towards these Europeans. The International Religious Freedom Act of 1998 needs to be updated with provisions protecting their freedoms on these religious issues. My bill would do just that," Congressman Stockman added.

If enacted, this legislation would go into effect immediately.

[Breaking news: European Union passes gun-control laws for USA]

SYDNEY: Sheik, ex-nurse, mother to stand trial over cutting of sisters

Sydney Morning Herald
May 23, 2014

Female genital mutilation: three charged with circumcising girls committed to stand trial

by Emma Partridge
Crime Reporter
The first three people ever charged with female genital mutilation in NSW were committed to stand trial at a Sydney court on Friday.

A mother, a retired nurse and a sheikh have been accused of circumcising two girls, aged six and seven, at a Sydney home in 2012.

Sex crimes police allege the procedure was done for cultural reasons.

The mother accused of allowing her two daughters to be "cut" stood before Parramatta Local Court clutching a crying baby girl.

She told the court she did not wish to say anything in relation to the charges or offer any evidence in her defence.

The court heard one of the victims had talked about how she had been cut on a ‘‘private part’’, while another little girl had said in an interview that she was hurt on her ‘‘bottom’’.

Nine people were originally charged with their involvement in the alleged mutilation, including the girl’s father, a Sydney doctor, whose charges were later dropped.

Auburn Sheikh Shabbir Vaziri, 56, had his bail continued after he was committed to stand trial on two counts of being an accessory after the fact to female genital mutilation and with hindering the police investigation.

The retired nurse charged with performing the procedure remained silent in court but hit the shoulder of a journalist with her hand outside court as she covered her head.

The case is next before court on June 20.

Earlier story

DENMARK: Baby in coma after circumcision

BT (Denmark) May 23, 2014 Læge: Omskæring gik helt galt i Nordvest - baby i koma Af: Silla Bakalus En lille baby er kommet så slemt til skade i forbindelse med en omskæring på en privatklinik på Nørrebro, at han er blevet lagt i koma. Sådan forlyder det i et facebook-indlæg, der de seneste dage er blevet spredt med lynets hast på facebook. Bl.a. har personer som Suzanne Bjerrehus samt den kendte overlæge og forsker i seksuel sundhed, Morten Frisch spredt indlægget. Sidstnævnte bekræfter, at historien er sand overfor BT. - Jeg kan bekræfte, at historien er sand. For jeg har talt med lægen, der har udført indgrebet, og han bekræfter, at drengen ligger i respirator, siger Morten Frisch. Ifølge indlægget, der angiveligt er skrevet af et familiemedlem til den lille dreng, havnede babyen i koma, efter han tirsdag blev omskåret på en privatklinik i Københavns Nordvest-kvarter. Efterfølgende måtte drengen indlægges på Hvidovre Hospital, hvor han altså blev lagt i koma. - Inden omskæringen gav han (lægen, red.) bedøvelse, desværre kom den amatør til at give babyen for meget bedøvelse ca. 8ml. (Han burde højst give 3ml. da babyen kun vejer 3 kg.) Kort efter omskæringen og mens babyen stadig var på klinikken begyndte han at havde svært ved at trække vejret og farven i ansigtet ændrede sig samtidig med der kom væske ud af munden på babyen, lyder ordlyden i indlægget... Dansk Folkepartis Liselott Blixt stillede i torsdag følgende spørgsmål til sundhedsminister Nick Hækkerup (S). - Kan ministeren af- eller bekræfte den historie, der florerer i medierne, om en baby der har fået for meget bedøvelse i forbindelse med en omskæring og nu er indlagt på Hvidovre Hospital? Liselott Blixt oplyser fredag formiddag til BT, at hun endnu ikke har fået svar Nick Hækkerup. ...

Bing translation (edited) May 23, 2014 Doctor: Circumcision went badly wrong in the Northwest - baby in a coma By: Silla Bakalus A little baby has suffered so badly in connection with a circumcision at a private clinic in Nørrebro, that he has been put into a coma. This was reported in a Facebook post that has gone viral. People like Suzanne Bjerrehus and the well-known consultant and researcher in sexual health, Morten Frisch, among others, have spread the story. He confirms the story to BT. -I can confirm that the story is true. For I have spoken with the doctor who performed the surgery, and he confirms that the boy is on life support, says Morten Frisch. According to the post, allegedly written by a family member of the little boy, the baby ended up in a coma after he was circumcised on Tuesday at a private clinic in the Northwest District of Copenhagen. Subsequently the boy was hospitalized at Hvidovre Hospital, where he was put into a coma. -Before circumcision, [the doctor] gave him too much anesthetic, about 8ml. instead of the maximum of 3ml. for a 3 kg baby. Shortly after circumcision and still at the clinic, the baby had difficulty breathing, the color of his face changed and fluid was coming out of his mouth, according to the initial post... Danish people's Party member Liselott Blixt asked to health minister Nick Haekkerup (Social Democrat) on Thursday: - -Can the Minister of-or confirm the story, which is rife in the media, about a baby who has gotten too much anesthesia for a circumcision and now is hospitalized at Hvidovre Hospital? Liselott Blixt told BT on Friday morning that she has not yet received a reply from Nick Hækkerup. ...

KENYA: CIRCUMCISING IS NOT PROTECTING AGAINST HIV

The real news: CIRCUMCISING IS NOT PROTECTING AGAINST HIV

Standard Digital (Kenya)
May 22, 2014

Male cut staff overwhelmed by work

by Gatonye Gathura
Kenya: The national male circumcision programme is in problems with most workers claiming burnout from high workload and impossible targets.

A survey of the programmes in Kenya, South Africa, Tanzania, and Zimbabwe shows local workers are the most fatigued.

Information coming directly from the workers indicates more than two thirds is already stressed while colleagues say this could be as high as 90 per cent.

“This is a worrying trend but not totally unexpected considering the repetitive nature of such procedures,” Dr George Githuka, the head of the programme, told The Standard yesterday.

He said with the new evidence, they will now seek a way out to save the workers from burnout while retaining them in the programme.

The survey carried out by among others Dr Peter Cherutich, deputy director at the National Aids and STI Control Programme, and edited by Nathan Ford of the World Health Organisation says worker fatigue could threaten what has become an example of success in Africa.

About seven years ago, Kenya set a target to increase the percentage of circumcised men nationally from 85 per cent to 94 per cent in three to five years by performing 860,000 procedures by last year.
But this work, which has won Kenya international accolades, is now said to have left workers totally exhausted.

The survey published two weeks ago in the journal Plos One had sampled 235 sites locally and some more in the other countries, with Kenya, which was the first to start the programme, having more workers say they are tired.

“The workers are burning out from performing a single task repeatedly in a high volume work environment that produces long work hours of intense effort,” says the study, which was funded by the American Government.

The physical strain of standing for many hours, and the monotony of repeating the same procedure are claimed to be some of the factors contributing to the fatigue.

EXTENDED PERIODS
“Other factors include attending to high volumes of clients over extended periods which translates into emotional exhaustion.”

These, the researchers say could be attributing to possible high rates of worker attrition from the programme. When asked about the impact of the scale-up of their work, the staff, both male and female, said the targets were not realistic which was leading to increased workload and hence the burnout.

“I don’t think the targets are the problem but it is mostly the repetitive nature of the job which can become monotonous,” says Dr Githuka.

Most studies on male circumcision, including the Kenya Aids Indicator Survey 2013 (KAIS), have so far concentrated on the quantity of procedures but none has shown it is achieving its primary objective of reducing HIV infections.

Started almost seven years ago, on the promise that it could reduce the risk of infection by 60 per cent, the KAIS report showed a spike in prevalence in places like Nyanza where the circumcision programme is most intense.

“Circumcision status, condom use, and sexual behaviour were measured through participants’ self-report, and therefore, responses may have been biased toward socially desirable answers,” says the KAIS report, which was commissioned by the Ministry of Health.

But if Kenya is to meet her ambitious targets, the authors say it will need to retain experienced workers who are willing to complete large numbers of procedures in high volume settings.

“The country may have to consider how best to continue to motivate these workers to maintain job-fulfillment, reduce burnout, prevent attrition and maximise performance.”