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March 6, 2000 (Boston) -- Putting aside questions of religion or personal preference, is there a compelling argument for having newborn boys circumcised? A new study in the journal Pediatrics showing that circumcising infants can protect against cancer of the penis is sure to ignite more debate over the procedure.
Circumcision is the removal of the foreskin from the penis. Historically performed for religious purposes, circumcision is now done for many other reasons, mainly cosmetic. Because it is an elective procedure, there is much disagreement on whether it should be performed routinely.
Research has shown that circumcision provides some health benefits to males throughout their lives. It has previously been found to protect against urinary tract infections. Circumcision is known to prevent closure of the foreskin so that it cannot be contracted over the head of the penis (a condition known as phimosis) and inflammation of the head of the penis and foreskin (called balanoposthitis) in childhood and adolescence. Studies have also shown that circumcised men have a lower risk for contracting HIV, the virus that causes AIDS, and other sexually transmitted diseases.
Edgar J. Schoen, MD, and colleagues studied more than 200 adult males enrolled in a large HMO to determine the relationship between circumcision and penile cancer. The overall rate of penile cancer in the United States is about 1 case per every 100,000 men. The researchers found that of 89 men with invasive penile cancer, 87 had not been circumcised. Among 118 men with a less serious form of cancer called carcinoma in situ, 102 were uncircumcised.
The study's authors say that parents of newborn boys should be informed of circumcision's protective benefits against cancer of the penis later in life.
The American Academy of Pediatrics (AAP) issued a statement on circumcision last year saying that although there is some scientific evidence that circumcising newborns provides medical benefits, there is not enough information to recommend routine circumcision. "In the case of circumcision, in which there are potential benefits and risks yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child," the statement says.
But some physicians, including the researchers involved in the Pediatrics study, disagree. Schoen, who led the American Academy of Pediatrics task force on circumcision in 1989, and his colleagues Thomas E. Wiswell, MD, and Stephen Moses, PhD, say the statement needs to be revised to be more supportive of circumcision.
Carole Lannon, MD, MPH, chairwoman of the AAP's 2000 circumcision task force and a clinical associate professor of internal medicine and pediatrics at the University of North Carolina at Chapel Hill, supports the AAP?s current statement. "When you're weighing risks and benefits, what you're being asked is whether you can recommend a surgical procedure on every newborn male," Lannon tells WebMD. "And when you look at the protective benefits, penile cancer is a very rare disease."
But protection against penile cancer is only one of the benefits of circumcision, says Schoen, clinical professor of pediatrics at the University of California, San Francisco, and director of perinatal screening for the northern California division of Kaiser Permanente.
"Circumcision is indicated for prevention of foreskin infections, which can be very troublesome ... and in avoidance of phimosis, where you'll have to be circumcised later on and it's more difficult," he tells WebMD.
Schoen, Wiswell, and Moses say they are concerned that the current AAP statement could leave the mistaken impression that the AAP is recommending against circumcision, rather than remaining neutral on the subject.
For now, physicians agree, parents should make the most informed decision possible for their child after discussing the pros and cons with their physicians.
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