Vasectomy acceptance has been declining in India during the past 20 years. Even if the risk of prostate cancer is marginally higher in vasectomized men, this risk in India has to be assessed against the immediate safety and other possible long-term benefits of this procedure. The Indian Council of Medical Research has launched a case-control study, which is unlikely to be time-consuming or beyond the available means and resources, in order to obtain definitive data on this problem. Meanwhile, vasectomy remains an excellent procedure for the couple seeking permanent methods of contraception, and specific efforts to promote its acceptance must continue in India.
PIP: The prevalence and acceptance of vasectomy in India has fallen from 74.2% (proportion of all sterilizations) in 1970 to 4.2% in 1992. Barriers in the organizational structure and poor access to services may contribute to the decrease in vasectomies. A review by the Indian Council of Medical Research (ICMR) has concluded that there is no consensus about an increased risk of prostate cancer among vasectomized men. The overall morbidity and mortality rates due to cancer in vasectomized men are equal to or lower than those of community-matched controls. Conflicting time-trends in the same study and differences between studies in the same country make it difficult to determine whether or not vasectomy decreases the risk of cardiovascular and cerebrovascular diseases. No studies have looked at an association between vasectomy and these diseases in India. WHO has asked the ICMR to participate in a multicountry study on prostate cancer. ICMR's Scientific Advisory Groups suggested that ICMR should also conduct a comprehensive case control study among men who are at least 50 years old who underwent vasectomy at least 10 years earlier. This ICMR-funded 2-year study, which has already begun, measures the risk of cardiovascular disease, cerebrovascular disease, and cancers other than prostate cancer. It will allow ICMR to weigh all the long-term risks and benefits of vasectomy in India against its short-term safety. The findings will provide potential clients information on the relative risk of prostate cancer and other diseases in vasectomized men in India, so they can make an informed choice. In the meantime, based on its immediate safety, low cost, and feasibility in a primary health care system, efforts to promote vasectomy acceptance in India must proceed, especially targeting couples wanting permanent contraception.