We determined the relation between newborn circumcision and both invasive penile cancer (IPC) and carcinoma in situ (CIS) among adult male members of a large health maintenance organization.
Circumcision status was ascertained by a combination of pathology reports, medical record review, and questionnaires for 213 adult male members of a large prepaid health plan who were diagnosed with IPC or CIS.
Of 89 men with IPC whose circumcision status was known, 2 (2.3%) had been circumcised as newborns, and 87 were not circumcised. Of 118 men with CIS whose circumcision status was known, 16 (15.7%) had been circumcised as newborns.
Our results confirm the highly protective effect of newborn circumcision against IPC and the less protective effect against CIS.
The incidence of penile cancer in Denmark,3 where circumcision is almost unknown, is lower than it is in the United States,4 where most men are circumcised.
I am puzzled by the statement of Dr Lansimies that the decision not to circumcise actually protects against penile cancer. Although it is true that small, developed countries like Finland and the Scandinavian nations have a low incidence of penile cancer, these risks are still 5-10 times as high as in developed countries in which essentially all baby boys are circumcised such as Israel (incidence 0.1/100,000). Uncircumcised men in underdeveloped countries with poor genital hygiene have penile cancer rates up to 100 times as high as in Israel.
Further, Dr Lansimies ignores the other medical benefits of newborn circumcision including the prevention of urinary tract infections in infants (about 10 times the risk in uncircumcised vs circumcised babies), and protection against heterosexually transmitted HIV infection (about 2-4 times lower risk in circumcised men as found in over 30 epidemiological studies). Prevention of balanoposthitis and phimosis and improved genital hygiene are other benefits.
We have received recent data from Dr Lansimies' country, Finland, showing that about 2000 Finnish males annually receive post-neonatal circumcision for medical reasons (presumably phimosis and recurrent balanoposthitis). Since there about 30,000 infant boys born annually in Finland, this means that about 6% of uncircumcised newborn boys will have to be circumcised later in life, when the procedure is more difficult and expensive.
In Finland male newborns are extremely rarely circumcised due to non- medical reasons. Penile cancer incidence in Finland is extremely rare less than 0.5 per 100 000 person-years. Age-adjusted mortality in penile cancer is one per million person years. According to Finnish experienca, parents decision not to circumcise their male children protects the men from penile cancer. Esko Länsimies, professor University and University Hospital of Kuopio, Finland