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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].Lifetime risk in the total population of circumcised men is only 1 in 50,000 to 1 in 12,000,000 [Wiswell, 1995; Wiswell, 1997a].In a study of 213 cases in California only 2 of 89 men with of invasive penile cancer was circumcised in infancy, so that uncircumcised men were stated to have a 22 times higher risk [Schoen et al., 2000b; Schoen et al., 2000c].

Penile cancer accounts for less than 1% of all malignancies in men in the USA and 0.1% of cancer deaths, the 5-year survival rate being approx. Mortality rate is 25-33% [Kochen & Mc Curdy, 1980; Maden et al., 1993].

Only 10 of these cases were in circumcised men [Schoen, 1991], and these had been circumcised later in life.

In Denmark (circumcision rate = 2%), penile cancer has been decreasing steadily [Frisch et al., 1995] in parallel with an increase in indoor bathrooms. Since the rate of penile cancer in Denmark is lower than in the USA other factors besides circumcision are also at work in these climatically, genetically, dietarily and culturally different countries.

The rate data in the USA has to be viewed in the context of the high proportion of circumcised men in the USA, especially in older age groups, and the age group affected (mean age at presentation = 60 years [Ries et al., 1998]), where older men represent only a portion of the total male population.

Thus the incidence of 1 in 100,000 men per year of life translates to 75 in 100,000 during each man's lifetime (assuming an average life expectancy of 75 years).

Penile cancer accounts for less than 1% of all malignancies in men in the USA and 0.1% of cancer deaths, the 5-year survival rate being approx. Mortality rate is 25-33% [Kochen & Mc Curdy, 1980; Maden et al., 1993].

Only 10 of these cases were in circumcised men [Schoen, 1991], and these had been circumcised later in life.

In Denmark (circumcision rate = 2%), penile cancer has been decreasing steadily [Frisch et al., 1995] in parallel with an increase in indoor bathrooms. Since the rate of penile cancer in Denmark is lower than in the USA other factors besides circumcision are also at work in these climatically, genetically, dietarily and culturally different countries.

The rate data in the USA has to be viewed in the context of the high proportion of circumcised men in the USA, especially in older age groups, and the age group affected (mean age at presentation = 60 years [Ries et al., 1998]), where older men represent only a portion of the total male population.

Thus the incidence of 1 in 100,000 men per year of life translates to 75 in 100,000 during each man's lifetime (assuming an average life expectancy of 75 years).

From 1998 to 2003, 4967 men were diagnosed with invasive squamous cell carcinoma in the USA (less than 1% of all new cancers in men; 0.81 cases per 100,000 men) [Hernandez et al., 2008a].