Penile Cancer Epidemiology and Risk Factors

A Contemporary Review

Antoin Douglawi; Timothy A. Masterson

Disclosures

Curr Opin Urol. 2019;29(2):145-149. 

In This Article

Lack of Circumcision

Circumcision is an effective treatment for recurrent balanitis and pathologic phimosis. It has also been used to manage recurrent UTI in young males. Neonatal circumcision was historically performed for religious reasons; however, medical literature has endorsed significant benefits relating to hygiene, inflammatory disorders, and reduced risk of penile cancer. The procedure has been recommended by the American Academy of Pediatrics (AAP) and Center for disease control (CDC).[3] Worldwide circumcision rates are low at 38% whereas prevalence in the United States was reported to be as high as 81% based on CDC data.[35] Voluntary male circumcision (VMC) has been promoted by multiple WHO initiatives in developing countries as it is known to decrease HIV transmission by as much as 60% for males.[36,37]

The protective nature of neonatal circumcision was first noted in Jewish patients in demographic studies in the 1930s as none of the patients examined were diagnosed with penile cancer.[38–40] Later studies confirmed these findings with a recent systematic review reporting 95–99% penile SqCC risk reduction and a 22-fold increase in prevalence among uncircumcised men.[3,41]

This procedure is not without controversy. A large body of evidence supports neonatal circumcision given the favorable risk--benefit analysis and potential protection from future disease.[42] Others argue that possible complications and unforeseen effects on sexual function and sensation should obligate shared decision making with the patient and that circumcision should be delayed until the child can give informed consent. It should be noted, however, that adverse events are exceedingly rare (0.5%) and are usually minor in nature.[43] A recent systematic review also showed no difference with regard to sexual function, satisfaction, or sensation.[44]

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