Early infant male circumcision and its relationship to penile carcinoma in older adulthood

Abstract

Aim Penile cancer is considered to be a rare neoplasia with circumcision widely considered to offer a prophylactic effect against the malignancy in later life. Though practised for thousands of years, male circumcision is still surrounded with controversy. In view of the local high mortality rate of penile cancer in a context where non-therapeutic childhood circumcision is non-existent, its utility has to be investigated to provide suggestions for its possible implementation. Hence, the research question: “Does having undergone a circumcision in early childhood reduce (or increase) the incidence of penile cancer in elderly men?”. Methods The material used in this study, a systematic review of the literature, was retrieved through the following databases: University of Malta e-library Hybrid Discovery (HyDi), EBSCOHost, PubMed and Google Scholar using the PICO elements: elderly men (P); circumcision (I); early childhood (I); and penile cancer (O). The selection of the articles was guided by the inclusion and exclusion criteria led by the PICO question. The reliability and validity of the search was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Three systematic and meta-analysis studies, one case-control study and one retroactive case ascertainment study were deemed eligible for critical appraisal which task was carried out using the Critical Appraisal Skills Programme (CASP). Results The results showed that, overall, circumcision is protective against penile carcinoma in cases of phimosis. However, a number of methodological flaws were detected. This included bias of some of the authors, low participant response rates in samples and the non-consideration of a number of social factors such as, inter alia, cigarette smoking and sexually transmitted diseases. Recommendations and conclusions The relationship between social factors, circumcision and the risk of penile carcinoma in later life, should be further investigated. Other warranted research could focus on the treatment of phimosis and balanitis as precursors of penile cancer. Additionally, educating parents and healthcare professionals on foreskin hygiene and infant circumcision is crucial in the long-term prevention of penile neoplasia.