Mark_Chid

I can live with a 3-fold increase on next to nothing.

And I'm willing to take the same risk with my infant son.

Corwin

I'm with Mark.

I'm willing to concede that circumcision lessens the risk of penile cancer somewhat. However, a threefold increase in jack shit... is still jack shit.

The problem is that there is a considerably greater than threefold risk of sexual problems as adults. I wouldn't have been willing to take that risk. The point is, however, somewhat academic... as I wasn't asked.

Ought Naught

I'm curious; how does the three-fold increase in penile cancer rates compare with the rate of complications for circumcision? Apologies if this has been answered already.

Corwin

Largely it depends on what you consider a 'complication.' A fair number of circumcision advocates don't consider something to be a complication unless your urethra is coming out the wrong end or more than half your penis has to be removed...

I myself have a much broader definition of 'complications' than 'if it doesn't require a sex change, he's all right.'

Amen-Moses

Originally posted by brighid:
Woe dude – I was asking a question in a very honest and inquiring way … my goodness …

Sorry if that seemed aggressive, it wasn't intended that way.

I am not sure there is any easy answer and there are many factors that contribute to cancer in any part of the body, and therefore many factors are relevant when making an accurate determination in regard to causation: such as diet, exposure to environmental carcinogens, exercise, genetic factors, sexual practice (many partners vs. few, protected vs. unprotected sex). I think those factors are especially relevant when discussing cancer and this topic. I would be curious to know if the different standards of sexual health education in Europe vs. the United States help to decrease the chance of reproductive cancers in men and women. This seems to be a probable factor and may logically pose a problem when attempting to examine the impact of circumcision (it’s benefits and detriments) in regard to different populations of people that have different environmental, genetic and lifestyle factors that would contribute to the variance in disease occurrences.

Basically (as far as penile cancer is concerned at least) the only factor that seems important is cleanliness, since we have managed to abolish the taboos against men actually touching their own members (so to speak) we have reduced penile cancers dramatically. Most cases of penile cancer now appear in the extremes of society (i.e in the homeless bums living on the streets) where cleanliness is difficult if not impossible.

Of course some penile cancers (in unclean patients) are in the foreskin so if you don't have one that is a reduced risk but the same argument would apply to ANY part of the body, i.e why should we risk breast cancer in males when it is a useless part of the body? Hack it off!

Of course when you apply this argument to parts of the body that people actually want to keep hold of, i.e Labia, Ear Lobes, Noses or finger/toe nails (my mother is currently undergoing treatment for a rare melanoma of the big toenail) then you start to realise how pathetic an argument it really is.

Amen-Moses

[ September 12, 2002: Message edited by: Amen-Moses ]</p>

Ought Naught

Point taken. The number that I've seen is a 1% rate of "acute complications". Now, setting aside for a moment what does or doesn't fall under that definition, I'm wondering what that 1% risk buys you...a sort of "cost/benefit" analysis, if you will.

[edited to add]

Just to avoid any confusion, this post was in response to Corwin.

[ September 12, 2002: Message edited by: Ought Naught ]</p>

Dr Rick

You've just made another unsubstantiated assertion.

What kind of sexual problems does circumcision cause, and what is you evidence?

Please also provide the evidence to support your previous and still unsubstantiated assertion that "UTI's are fairly rare, and easily treated" in neonates (as opposed to adults); they can and do kill infants and are considered a serious illness.

Also, you still have not posted any evidence supporting your prior assertion that circumcision results in "decreased sexual enjoyment" That's a claim absent supporting clinical data that's been made because circumcision decreases tissue surface area, but if it were true, then men with smaller penises and women with smaller clitori would enjoy sex less than others, too.

You also asserted that the decreased risk of penile cancers associated with circumcision can be realized by "bathing" but did not post any supporting evidence.

Rick

Dr Rick

That's a good question: Here's a cost/benefit analysis, but it only addressed prevention of neonatal UTIs and did not compare it with the cost of circumcision complications; a serious flaw. The entire abstract is posted earlier on the thread if you want to see it.

Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life.

Schoen EJ, Colby CJ, Ray GT.

Departments of Genetics and Pediatrics, Kaiser Permanente Medical Care Program of Northern California, Oakland, CA 94611, USA. edgar.schoen@ncal.kaiperm.org

The study group consisted of a cohort of 28 812 infants delivered during 1996 at KPNC hospitals; of the 14 893 male infants in the group, 9668 64.9% were circumcised. A second cohort of 20 587 infants born in 1997 and monitored for 12 months was analyzed to determine incidence rates...In 1996, total cost of managing UTI in uncircumcised males ($155 628) was 10 times higher than for circumcised males ($15 466) despite the fact that uncircumcised males made up only 35.1% of the male patient base in 1996, reflecting the more frequent occurrence of UTI in uncircumcised males (132 episodes) than in circumcised males (22 episodes), and the larger number of hospital admissions in uncircumcised males (38) than in circumcised males (4). The incidence of UTI in the first year of life was 1:47 (2.15%) in uncircumcised males, 1:455 (.22%) in circumcised males, and 1:49 (2. 05%) in females. The odds ratio of UTI in uncircumcised:circumcised males was 9.1:1. CONCLUSIONS: Newborn circumcision results in a 9. 1-fold decrease in incidence of UTI during the first year of life as well as markedly lower UTI-related medical costs and rate of hospital admissions. Newborn circumcision during the first year of life is, thus, a valuable preventive health measure, particularly in the first 3 months of life, when uncircumcised males are most likely to be hospitalized with severe UTI.

Here's another one; the problem here is that it's older (1996) and so does not incorporate any of the recent findings on decreased HIV aquisition rates. Also, the criteria they used and how they weighted it is not apparent:

Neonatal circumcision revisited.

Fetus and Newborn Committee, Canadian Paediatric Society.

OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external financial support has been received by the Canadian Paediatric Society, or its members, for any portion of the statement's preparation.

Here's one, but it's only descriptive:

Sex Transm Infect 1998 Oct;74(5):368-73 Related Articles,

Male circumcision: assessment of health benefits and risks.

Moses S, Bailey RC, Ronald AR.

Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.

OBJECTIVES: Globally approximately 25% of men are circumcised for religious, cultural, medical, or parental choice reasons. However, controversy surrounds the procedure, and its benefits and risks to health. We review current knowledge of the health benefits and risks associated with male circumcision. METHODS: We have used, where available, previously conducted reviews of the relation between male circumcision and specific outcomes as "benchmarks", and updated them by searching the Medline database for more recent information. RESULTS: There is substantial evidence that circumcision protects males from HIV infection, penile carcinoma, urinary tract infections, and ulcerative sexually transmitted diseases. We could find little scientific evidence of adverse effects on sexual, psychological, or emotional health. Surgical risks associated with circumcision, particularly bleeding, penile injury, and local infection, as well as the consequences of the pain experienced with neonatal circumcision, are valid concerns that require appropriate responses. CONCLUSION: Further analyses of the utility and cost effectiveness of male circumcision as a preventive health measure should, in the light of this information, be research and policy priorities. A decision as to whether to recommend male circumcision in a given society should be based upon an assessment of the risk for and occurrence of the diseases which are associated with the presence of the foreskin, versus the risk of the complications of the procedure. In order for individuals and their families to make an informed decision, they should be provided with the best available evidence regarding the known benefits and risks.

...and here's one more; a serious flaw with this one is that the analysis didn't include the decreased HIV aquisition rates.

Pediatrics2000 Jan;105(1 Pt 3):246-9

Trade-off analysis of routine newborn circumcision.

Christakis DA, Harvey E, Zerr DM, Feudtner C, Wright JA, Connell FA.

Department of Pediatrics, University of Washington, Seattle, USA. dachris@u.washington.edu

BACKGROUND. The risks associated with newborn circumcision have not been as extensively evaluated as the benefits. OBJECTIVES. The goals of this study were threefold: 1) to derive a population-based complication rate for newborn circumcision; 2) to calculate the number needed to harm for newborn circumcision based on this rate; and 3) to establish trade-offs based on our complication rates and published estimates of the benefits of circumcision including the prevention of urinary tract infections and penile cancer. METHODS. Using the Comprehensive Hospital Abstract Reporting System for Washington State, we retrospectively examined routine newborn circumcisions performed over 9 years (1987-1996). We used International Classification of Diseases, Ninth Revision codes to identify both circumcisions and complications and limited our analyses to children without other surgical procedures performed during their initial birth hospitalization. RESULTS. Of 354, 297 male infants born during the study period, 130,475 (37%) were circumcised during their newborn stay. Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis. Based on our findings, a complication can be expected in 1 out every 476 circumcisions. Six urinary tract infections can be prevented for every complication endured and almost 2 complications can be expected for every case of penile cancer prevented. CONCLUSIONS. Circumcision remains a relatively safe procedure. However, for some parents, the risks we report may outweigh the potential benefits. This information may help parents seeking guidance to make an informed decision.


Rick

[ September 12, 2002: Message edited by: rbochnermd ]</p>

Mark_Chid

You have never addressed the real question.

Does the good done to a child by the health benefits of circumcision outweigh the harm done by an unnecessary surgical procedure that permanently alters the body of that child in a way which he has a good chance of resenting in later life?

Dr Rick

The real medical issue regarding circumcison is: do the benefits outweigh the risks (harm)?

On something as simple as whether or not this is the right question, I've been repeatedly challenged...

<strong> ...and then sidetracked with unsubstantiated assertions as the one you make.

What evidence do you have to support your claim?

Rick

[ September 12, 2002: Message edited by: rbochnermd ]</p>