Circumcision

The incidence of penile cancer is far lower in countries where neonatal circumcision is routine. Furthermore, a renewed interest in circumcision in health promotion has been fuelled due to the observed 50-60% risk reduction of contracting HIV demonstrated in some studies28,39 (Fig. 16.4). In the UK, circumcision is performed for medical reasons in only 0.3% of boys under the age of five.40 Circumcision reduces the risk of developing HPV by two-thirds.41 This model is applied to estimate the potential benefit of circumcising all males up to the age of 12 commencing in 2012. It assumes the maximal benefit of reducing the risk of penile cancer by two-thirds. By 2050 only men under age 50 will have been exposed to the programme. This translates into an overall increase of 5% in incidence by 2050 relative to the projected rate (Fig. 16.5) in 2050 which would increase by 47%. More patients would be in the older part of the range, the median age at presentation being between 65 and 69 years. Thus the initial benefit in a programme of routine neonatal circumcision would be seen in the prevention of penile cancer in younger men, at an age when they are more sexually active.

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