Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
NEJM Cervical Cancer Study Has Fatal Flaws
- Marilyn Fayre Milos (27 April 2002)
-
Circumcision and cervical cancer
- Tom H Hughes-Davies (28 April 2002)
-
Misuse of the medical literature
- John Travis (29 April 2002)
-
Why can't medicine self-correct?
- Van Lewis (30 April 2002)
-
Correction to above response
- Tom H Hughes-Davies (2 May 2002)
|
|
|||
|
Marilyn Fayre Milos, Executive Director National Organization of Circumcision Information Resource Centers, POB 2512, San Anselmo, CA 94979
Send response to journal:
|
EDITOR—Reduction of the incidence of cervical cancer is a laudable objective. Castellsagué and others have attempted to show that male circumcision would reduce the incidence of cervical cancer.1 Unfortunately, this study has numerous methodological flaws that cast serious doubts on the validity of its findings. The New England Journal of Medicine has published an article that somehow seems to have escaped their usually rigourous peer review. Castellsagué et al. drew data from seven previous studies carried out in geographically diverse nations. This is a serious flaw in the study because cancer rates vary sharply between different regions and different population groups.2 Most of the circumcised males (61%) were concentrated in the Phillipines while most of the non-circumcised males were in other countries, including Columbia and Brazil where there is a high incidence of HPV infection. This may cause suscepibility of non-circumcised males to HPV infection to be overstated. Castellsagué et al. also ignored other confounding factors, such as smoking by the female subject. There is an absolute failure to control this important confounding factor.3,4 The World Health Organisation recently identified the use of oral contraceptives as a risk factor for cervical cancer.5 Castellsagué and colleagues also ignored this confounding factor. Castellsagué et al. made unpublished "adjustments" to their data. These unpublished adjustments, plus the omission of controls for so many confounding factors in addition to the geographal diversity problem, create substantial doubt regarding the validity of the findings. This study is fatally flawed. Although this study is fatally flawed, The National Organization of Circumcision Information Resource Centers (NOCIRC) expect that its publication soon will produce calls for the universal circumcision of male children. Courts, however, generally have held that healthy functional tissue may not be excised from a minor child for the benefit of another person.6 The BMJ previously has published reports of serious editorial problems at the New England Journal of Medicine.7,8 One suspects, after reviewing this regretable article, that the problems persist. The New England Journal of Medicine has an ethical duty to publish a rebuttal to this flawed study. Marilyn Fayre Milos, R. N., Executive Director,
|
|||
|
|
|||
|
Tom H Hughes-Davies, Retired paediatrician Slades Cottage, Breamore, Fordingbridge, Hampshire SP6 2EJ
Send response to journal:
|
Castellsague's conclusion that circumcision increases the risk of cervical cancer rests on a mixed batch of figures for monogamous women with promiscuous partners. 20 partners of 199 such women with cancer were circumcised as were 16 partners of 175 women without cancer - or 10.05% versus 9.14%. If a single couple moved to the group without cancer or circumcision the figures would be 19 of 198 and 17 of 176, or 9.59 v 9.65% respectively. Should we then conclude that circumcision was a cause of cervical cancer? |
|||
|
|
|||
|
John Travis 22903
Send response to journal:
|
EDITOR—Charatan1 reports that the New England Journal of Medicine has published a study2 that finds male circumcision may protect the female partner from human papillomavirus (HPV) infection and cervical cancer.
Male circumcision is a peculiar operation with strong emotional overtones due to its alteration of the phallus. Male circumcision has a long history of false claims of efficacy in preventing all manner of disease.3 These claims apparently are generated by the emotions of circumcised individuals.4 Goldman observes that:
Misuse of the scientific literature is not confined to authors. Editors may also misuse scientific literature for emotional reasons. The late Abraham Wolbarst, M.D., a notorious promoter of male circumcision, claimed that male neonatal circumcision would prevent penile cancer.5 Numerous case reports soon appeared in the literature documenting the falseness of Wolbarst's claims.6 Wolbarst's claims that circumcision could prevent penile cancer are no longer believed by creditable sources.7 Wynder and others claimed in 1954 that male circumcision could prevent cervical cancer8 but were forced to retract their claims in 1960.9,10 Terris et al. found no differences in circumcision status of husbands of cervical dysplasia patients and controls.11 Some studies have shown opposite results to those of Castellsaqué et al. Sumitran reported low rates of cervical cancer among the Orang Asli people of Malasia although their men are not circumcised,12 while Megafu reported high rates of cervical cancer among the Ibo people of Nigeria although their men are circumcised.13 Today we know that the major risk factor of both penile cancer and cervical cancer is HPV infection.14 Male circumcision cannot protect the male from the ravages of HPV.5,15 It is unreasonable to suppose that it can magically protect the female partner. The only reliable methods of protection from HPV infection are the same reliable methods that protect from HIV infection—abstinence, monogamy, and use of condoms. The editors of the New England Journal of Medicine should be acutely embarrassed for having printed such rubbish. A retraction of the article would be appropriate. John W. Travis, MD, MPH, Executive
Secretary, References
|
|||
|
|
|||
|
Van Lewis, NOCIRC of Florida, State Director P.O. Box 323, Panacea, Florida, 32346, USA
Send response to journal:
|
Medicine's worst mistake over the last 150 years is genital mutilation of healthy children, male, intersexed, and, until recently - and even still in some quarters - female. The recent New England Journal of Medicine article from Castellsagué and others shows that even with many leading medical and ethical authorities trying hard to help it do so, world medicine, and especially US medicine, still has not developed the intellectual awareness, ethical integrity, and the human courage necessary to repudiate at last this unnecessary, unjustified, always damaging, sometimes lethal violation of the inalienable human right to bodily integrity. http://MontaguNocircPetition.org/ is a new web site where people of conscience the world over can join Francis Crick, Nobel Laureate discoverer of DNA, Jonas Salk, creator of the Salk polio vaccine, and others endorsing the Ashley Montagu Resolution to End the Genital Mutilation of Children Worldwide. The children and the future will be grateful for the endorsements of your readers. Van Lewis |
|||
|
|
|||
|
Tom H Hughes-Davies, Retired paediatrician SP6 2EJ
Send response to journal:
|
Dr Antanopoulos has kindly pointed out my error in writing 'increases' in the first sentence of my response. The paper of course argues that circumcision reduces the risk of cervical cancer. Please accept my apology for any confusion caused. |
|||