Should routine neonatal circumcision be a policy to prevent penile cancer? | Opinion: No
Bibliographic record
Abstract
Routine neonatal circumcision remains a controversial topic. The most recent Canadian Paediatric Society does not recommend routine circumcision of every newborn male (1). And although prior statements from the American Academy of Pediatrics re-commended against circumcision, the most recent recommendation states that circumci-sion outweigh the risk and the procedure’s benefits justify it for families who want it (2). The benefits mentioned by the American Academy of Pediatrics included prevention of urinary tract infections, transmission of sexually transmitted infections, and penile can-cer. Prevention of penile cancer may be related to increasing daily hygiene and decrea-sing sexually transmitted infections such as human papilloma virus (HPV) in circumcised males. However, with improvements in daily hygiene and sexually transmitted infection prevention strategies, neonatal circumcision may not be critical for the prevention of penile cancer, especially in western countries. The association between lack of circumcision and penile cancer has been well documented (3). A meta-analysis found a strong protective effect of childhood circum-cision on invasive penile cancer in 3 studies (OR 0.33; 95% 0.13-0.83) (3). However, in other studies when analyses were restricted to boys without a history of phimosis, the meta-analysis found that the protective effect of childhood circumcision on invasive di-sease no longer persisted (3). In addition, penile cancer continues to be one of the rarer malignancies in the world. In the United States where circumcision is prevalent, the rarity of disease is highlighted by its decreasing incidence. An analysis from the Surveillance, Epidemiology and End Results (SEER) database showed that the penile cancer incidence decreased to 0.58 per 100,000 in 1993-2002 from 0.84 per 100,000 in 1973-1982 in the United States (4). However, there is also a similar trend in countries with low circumcision rates such as Denmark and Finland (5, 6). In Denmark, penile cancer risk decreased from 1.15 per 100,000 in the 1940s to 0.82 per 100,000 in the late 1980s (5). Finland reported an incidence rate of 0.5 per 100,000 (6). Coupled with the rarity of penile cancer and conflicting evidence in the literature, it is hard to justify routine neonatal circumcision for all healthy males, including those without any preputial abnormalities, solely for the prevention of penile cancer. Despite its rarity, there are several common factors that have been implicated to cause penile cancer. Factors resulting in phimosis, balanitis, and smegma have been associated with penile cancer in a meta-analysis (7). This has often been attributed to the
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.068 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.004 | 0.008 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.032 | 0.021 |
| Insufficient payload (model declined to judge) | 0.040 | 0.016 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".