Circumcision and Prostate Cancer Mortality in the Cancer Prevention Study-I Público

Abstract

PROBLEM

Previous research has examined the role of sexually transmitted infections (STIs) on prostate cancer etiology. A meta-analysis of 34 case-control, 10 nested case-control, and 3 cohort design studies found that men with a history of any STIs had a 50% higher risk of prostate cancer. Circumcision has also been found to be associated with a lowered risk for some STIs, with the notable exception of gonorrhea. However, based on the literature, previous studies examining the association between circumcision and prostate cancer have been limited to 7 case-control and 1 cross-sectional studies. Thus far, no studies have attempted to examine the association with prostate cancer mortality as the main outcome and studied the association in a cohort study.

METHODS

The association between self-reported circumcision status and prostate cancer mortality was examined using data from 449,320 men in the Cancer Prevention Study I (CPS-I) cohort. Information on date and cause of death was collected by volunteers and verified using death certificates. Cox proportional hazards modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During a median follow-up time of 12.8 years, 1,990 men died of prostate cancer. No statistically-significant association was found between circumcision and prostate cancer mortality (HR=0.96, 95% CI 0.85-1.08).

CONCLUSIONS

This study found no association between circumcision and prostate cancer mortality compared to seven out of eight case-control studies that found an inverse association between circumcision and prostate cancer incidence. Further studies should be conducted using more recent data.

Table of Contents

DISTRIBUTION AGREEMENT ………........................................................................................……………………………..……………….. i

APPROVAL SHEET …………………….......................................................................................………………………………...…………..… ii

ABSTRACT COVER PAGE …………........................................................................................…………………………………..………….… iii

ABSTRACT ………………..........................................................................................………………………………………………………….… iv

COVER PAGE ……………..........................................................................................………………………………………………….……….… v

ACKNOWLEDGEMENTS …………........................................................................................…………………………………….………….… vi

TABLE OF CONTENTS ………………........................................................................................…………………………..……….……….… vii

LIST OF TABLES …………………….........................................................................................……………………………………...……..… viii

CHAPTER

1              BACKGROUND AND LITERATURE REVIEW …………....................................................................................………………...… 1

Background …………………………………………………….........................................................................….........................……………… 1

Significance ……………………………………………………..................................................................................................………………… 2

2              MANUSCRIPT ………………………………………………......................................................................................………………..… 6

Abstract ……………………………………………………………………...................................................................................................…..… 6

Introduction ………………………………………………………………..................................................................................................……… 7

Methods ………………………………………………………………...................................................................................................………..… 8

Study Population …………………………………………………...........................................................................................................……… 8

           Exposure …………………………………………….....................................................................................................…………………… 8

           Outcome ……………………………………………....................................................................................................………………….… 9

           Statistical Analysis ………………………………..................................................................................................…………………….… 9

Results ……………………………………………….....................................................................................................………………………..… 10

Discussion ………………………………………………………….....................................................................................................…………… 15

References …………………………………………………………….....................................................................................................………… 19

Supplemental Tables ………………………………………………...................................................................................................……..…… 22

3              SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS ………………….......................………………....… 24

Summary ………………………………………………………………......................................................................................................…….… 24

Public Health Implications …………………...............……..............................................................................................………………..… 24

Future Considerations ………………………….……………...................................................................................................……………...… 25

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Oncology Health Sciences, Epidemiology
Palavra-chave	Circumcision, Male Prostate Cancer Mortality Mortality Cohort Study Prostate Cancer
Committee Chair / Thesis Advisor	Dr. Michael Goodman, Emory University
Committee Members	Dr. Mia Gaudet, Emory University

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