In fact penile cancer is so rare in a man who had been circumcised in infancy, that when it does occur it can even be the subject of a published case report [Kanik et al., 1997].

The finite residual risk appears to be greater in those circumcised after the newborn period, but still less than the uncircumcised.

Circumcision later in life is much less effective [Tsen et al., 2001].

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In this regard penile cancer in circumcised men (av.

age 62) in Saudi Arabia (where circumcision is performed in older children) was associated with ritual, nonclassical, vigorous circumcision [Seyam et al., 2006].

Owing to earlier diagnosis, incidence has been decreasing by 1.9% per year in Blacks and 1.2% in Whites [Goodman et al., 2007].

The majority (61%) were diagnoses at the localized stage. Another report gives figures for 1993 to 2002 of 1.01 per 100,000 for white Hispanics, 0.77 for Alaskan native/American Indians, 0.62 per 100,000 for Blacks and 0.51 for whites who are not Hispanic [Barnholtz-Sloan et al., 2007].

Perhaps not surprisingly this accords with the incidence that is actually seen (as stated in the first paragraph).

In 5 major series in the USA, starting in 1932 [Wolbarst, 1932], not one man with invasive penile cancer had been circumcised neonatally [Maden et al., 1993], i.e., this disease is almost completely confined to uncircumcised men.

A study in Spain concluded that "circumcision should be performed in childhood [as a] prophylactic [to penile cancer]" [Sanchez Merino et al., 2000].

As a historical point of interest, Diego Rivera, the famous Mexican muralist, who had multiple sexual partners over many years in a country where most men are uncircumcised, developed penile cancer [Schoen, 2007d].

This correlates inversely with incidence of circumcision between these groups.