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  1. 1

    Vasectomy: avoiding panic over prostate cancer.

    Haq F

    POPULI. 1993 Mar; 20(3):4-5.

    A study published in the Journal of the American Medical Association linked vasectomies to a 66% elevated risk of prostate cancer among men 15-20 years after the surgery, although a causal relationship between vasectomy and prostate cancer was not proven. Although 2 previous studies found no linkage, the study by Edward Giovannucci of Boston drew broad attention in the medical community. Prostate cancer in the industrial world is quite high: about 1 in 11 males in the US will develop prostate cancer for unexplained reasons. But the US-based Association for Voluntary Surgical Contraception (AVSC) warns that the public or medical professionals should not overreact to this new information. In 1991 a group of experts convened by WHO concluded that based on existing biological and epidemiological evidence any causal relationship between vasectomy and the risk of prostate or testicular cancer was unlikely and changing policies concerning vasectomy was unjustified. In contrast to the author's conjecture, experts at AVSC pointed out that models of cancer development suggest that a decrease in prostatic secretions following a vasectomy actually would reduce cancer risks. The cases of prostate cancer are unknown, and vasectomy is not associated with any increase in mortality. Family Health International (FHI) is concerned about the effect of perceptions in developed countries on policy in developing countries. However, the risks associated with vasectomy are still less than the risks of pregnancy. In India health risks linked to pregnancy and childbearing are 400 times greater than those linked to contraception. Further research, the continuation of vasectomy policies, and annual examinations for prostate cancer among men who have undergone vasectomies and for all men aged 50-70 years are recommended. The American Urological Association urges men who have had vasectomies not to have them reversed to try to prevent cancer.
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  2. 2

    Why men avoid vasectomies.

    Stein R

    WASHINGTON POST HEALTH. 1993 Jan 12; 11.

    In the United States a total of 490,000 men obtain vasectomies each year compared to more than 600,000 women who sought sterilization in 1992 via tubal ligation. Vasectomy is often permanent, and even monogamous men avoid the procedure, partly because of the misconception that vasectomies reduce sexual prowess, fear of emasculation, and its confusion with castration. Also, there have been suggestions that vasectomy may increase the risk of prostate cancer. The World Health Organization experts in 1991 concluded there was no reason to stop recommending vasectomies. However, 2 large studies at Harvard University in Boston have added to the controversy. The 1st study involved more than 23,000 husbands of women in the Nurses' Health Study and followed the men from 1976 until 1989. A preliminary analysis found that having a vasectomy appears to increase the risk for prostate cancer by 37%. The 2nd study involved more than 51,000 men in the Health Professionals Follow-up Study. Similarly, preliminary analysis indicated that vasectomized men appear to have a 21% increased risk for prostate cancer. These findings cause concern, since 4 million American men have had the procedure. A vasectomy involves severing each vas deferens, which carries sperm from the testicles into the penis. In the new, no-scalpel vasectomy technique the doctor makes 1 tiny puncture, and for the patient there is less swelling and bleeding. 300 US doctors are trained to perform the procedure, which was pioneered in China. Failure usually occurs because the vasa reconnect by themselves. Only a small percentage of men experience complications, most commonly excess bleeding or infections. Microsurgical techniques result in a 98% chance of reconnecting the vasa, if a reversal of the procedure is desired. But only about half of those who undergo a reversal succeed in fathering children, because after a vasectomy the immune system often produces antibodies against sperm.
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  3. 3
    Peer Reviewed

    Vasectomy and prostate cancer.

    Choo V

    Lancet. 1993 Feb 20; 341(8843):486-7.

    2 well-designed cohort studies involving 73,000 men found that the risk of prostate cancer increases after vasectomy. In the Health Professionals Follow-up Study vasectomized men had an age-adjusted relative risk of prostate cancer of 1.66. The risk was 1.85 among those who had had the operation at least 22 years previously. In the Nurses Health Study the age-adjusted relative risk of prostate cancer for vasectomized men was 1.56 overall and 1.89 for those who had had their vasectomy at least 20 years previously. The long-term safety of vasectomy raised by these reports could reduce its acceptability by about 42 million couples worldwide who rely on it. It is not clear whether the relation is causal. Prostate cancer develops in about 1 of 1 men in the US, and most of those affected would not have undergone vasectomy. Since the causes of prostate cancer are unknown, it is not sure whether true risk factors were equally distributed between vasectomized and control groups, a point supported by the finding that in the Nurses' Health Study the vasectomized group has a lower total mortality rate than did the controls. Further uncertainties are the weakness of the association, the lack of relation between vasectomy and prostate cancer in 3 other cohort studies, and the doubtful plausibility of the biological explanations. The experts convened by the World Health Organization in 1991 concluded, based on existing biological and epidemiological evidence, that a causal relation between vasectomy and prostate cancer was unlikely. However, the risk ought to be mentioned in prosterilization counseling, and vasectomized men aged 50-70 should consider annual checks for prostate cancer. The WHO Human Reproduction Program pointed to the up to 50-fold lower annual incidence of prostate cancer in developing countries compared to some parts of the US. WHO-supported pilot studies are under way, and the main case-control study is expected to start in 1994.
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