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Friday 4 December 1998 New report debunks health benefits of circumcision Sharon Kirkey The Ottawa Citizen A major Canadian study has found that 195 baby boys would have to be circumcised to prevent one baby from being hospitalized for a urinary tract infection. Circumcising baby boys doesn't protect them from developing urinary tract infections – a reason often used to justify the procedure -- nearly as much as some believe, according to the study to be published tomorrow in the British medical journal The Lancet. The study by Toronto researchers, which involved almost 60,000 boys born in Ontario between 1993 and 1994, found that uncircumcised infant boys had, at the most, a 3.7 times greater risk of being admitted to hospital with a bladder or kidney infection than circumcised infants. Previous studies have suggested the risk is as low as five times to as high as almost 40-fold. Overall, they found that the rate of urinary tract infection was less than one per cent – whether or not the baby had his foreskin removed. "It appears that circumcising one's child solely for the benefit of lowering the risk of hospital admission for UTI (urinary tract infection) may be medically unnecessary," says Dr. Teresa To, of the Hospital for Sick Children in Toronto, whose study involved 60,000 male babies born in Ontario between 1993 and 1994. The organization that represents Canada's 2,000 pediatricians says most doctors today wouldn't recommend a baby's foreskin be removed just to prevent the risk of a bladder infection, and that social -- not medical reasons --are what are driving circumcision rates. "They want their little boy to, most of all, match dad, then next perhaps match the brothers, and to go along with their religious convictions," says Dr. Douglas McMillan, chair of the Canadian Pediatric Society's fetus and newborn committee. (In the Jewish faith, for example, circumcision is a religious ritual that almost all Jews follow.) But anti-circumcision groups say the new research is just the latest to discredit older studies that have been used to support non-religious circumcision as a way to prevent health problems later. "A benefit short of a therapeutic benefit is not an ethically valid benefit when it comes to removing a healthy, normal body part without personal consent," says John Antonopoulos, of the Circumcision Information Resource Centre in Montreal. Circumcisions, which are uncommon in northern European countries, Central and South America and Asia, are among the most common surgical procedures performed in Canada and the U.S. The procedure involves cutting away the inner and outer layers of the foreskin. Minor complications, such as bleeding and infection, occur in between five to 10 per cent of cases. In extremely rare cases, the procedure can result in damage to the penis, ranging from lacerations to permanent deformity or, in even rarer cases, amputation. Two years ago, the Canadian Pediatric Society concluded that the benefits and harms of circumcision were "so evenly balanced" that there was no valid medical reason to justify routine male circumcision. In Canada, circumcision rates have been falling gradually, but they vary widely across the country. In Newfoundland, the procedure is rarely done but in some western provinces, a majority of boys are circumcised. Several years ago, Dr. To looked at circumcision rates in Ontario as part of a special "atlas" on medical procedures produced by the Institute for Clinical Evaluative Sciences in Toronto. She found huge variations in the rate of circumcisions in Ontario, from a high of more than 700 boys per 1,000 born in Essex County to about 62 per 1,000 in the Kingston area. Ottawa-Carleton ranked 12th out of 33 regions surveyed, with 493 circumcisions for every 1,000 male births. Dr. To wanted to know how the babies did after they were circumcised. She and researchers at the Hospital for Sick Children, the University of Toronto and the Institute for Clinical Evaluative Sciences looked at 60,000 babies born in Ontario between April 1993 and March 1994. About half of the boys were circumcised before they were one month old. Each of the babies was matched to an uncircumcised boy born on the same day. The babies were followed for three years, and hospital records were used to determine how many were admitted to a hospital before March 1996 with a urinary tract infection. Eighty-three of the circumcised boys developed an infection that sent them to hospital, compared with 247 of the uncircumcised boys – a 3.7 times greater risk for the uncircumcised boys. However, the researchers also used OHIP billings to get a sense of the number of babies that developed an infection but were treated at home with medication. They found that for every circumcised infant admitted for a urinary tract infection, there were 11 others that had an infection that didn't require hospitalization, compared to five for each of the uncircumcised infants. "So if you put all this into consideration, the risk of urinary tract infection in the uncircumcised (babies) would be even lower than the four-fold we reported," Dr. To said in an interview. "There is a protective effect during the first three years of life, but it's not as big as the other studies reported." Studies involving infant boys born in U.S. army hospitals showed a 10-times greater risk of urinary tract infection among uncircumcised boys. Older studies have put the risk as high as 39 times greater. Mr. Antonopoulos, of the anti-circumcision group, says that urinary tract infections are "easily treatable", and that research has shown that one of the best ways to prevent them is through breast-feeding. He said that many urinary tract infections in uncircumcised babies are caused by parents or health professionals mishandling the foreskin when cleaning the baby, "rather than leaving well enough alone." Dr. To said the decision whether or not to circumcise "is always very complex. There are so many other factors effecting the decision, like social, personal and religious preferences." She also stressed that her study only focused on urinary tract infections. Other studies have found a slightly lower risk of sexually transmitted diseases, including HIV, in circumcised males. Penile cancer, an extremely rare cancer, has also been shown to be slightly lower in circumcised men. Copyright 1998 Ottawa Citizen ----------------------------------------------------------------- http://www.nationalpost.com/news.asp?f=981204/2075211 Friday, December 04, 1998 New study questions need for circumcision Anti-infection benefits much lower than once thought Tom Arnold National Post The often cited benefit of circumcising newborns to reduce the risk of severe kidney and bladder infections is much lower than previously reported, according to a major Canadian study to be published tomorrow in a leading international medical journal. The three-year study of more than 58,000 Canadian male infants indicates circumcision in newborn boys does lower the risk of urinary tract infections, but concludes that earlier studies suggesting infection rates are up to 39 times higher for uncircumcised children are vastly overestimated. "It does lower the risks of urinary tract infection during the first three years of life, but the effect is not as dramatic as other studies have previously suggested," said Dr. Teresa To, a University of Toronto associate professor and lead author of the study. "Other studies have said that uncircumcised boys have a risk of urinary tract infection ranging from about five times to 39 times higher than circumcised boys. A lower risk of urinary tract infections in the bladder and kidneys is one of the most common reasons to support circumcision of newborns. "So this is a very important piece of news," added Dr. To of the Hospital for Sick Children's population health sciences research program. The study concludes that uncircumcised infants have a 3.7 times greater risk of being admitted to hospital with an urinary tract infection than circumcised infants. Dr. To's research appears in the Dec. 5 edition of The Lancet. The study also found hospital admissions for urinary tract infections in healthy boys is extremely low, said Dr. To. "Almost nearly 200 boys would have to go through circumcision in order to prevent one admission for urinary tract infection." The study suggests 195 circumcisions would need to be performed to prevent one hospital admission for urinary tract infection in the first year of life, a rate of less than 1%. The study included 58,434 males who were born between April 1993 and March 1994. They were followed for three years to determine if they required hospitalization for a urinary tract infection. Some 29,217 babies were circumcised before the age of one month and were each matched to an uncircumcised boy with the same date of birth. During the follow-up period, 83 circumcised boys were admitted, in comparison to 245 uncircumcised infants. "I'm in agreement with the findings," Dr. Doug McMillan, chairman of the foetus and newborn committee for the Canadian Paediatric Society. The Canadian Paediatric Society has found the only benefit to circumcision – a procedure that involves cutting away the inner and outer layer of foreskin – is a reduced risk of urinary tract infection, but it has argued that it afflicts less than 2% of males and can be treated with antibiotics. "There is no need for a routine circumcision, but we would respect the rights of parents to make an informed decision," added Dr. McMillan, professor of paediatrics at the University of Calgary. Last year, a study led by Hospital for Sick Children researchers demonstrated that not only do male infants feel pain during circumcision, but they remember that pain six months later when receiving their routine vaccination. Circumcision remains controversial, but it is still a common procedure. About 30% of male infants in Canada are circumcised annually. The main reason for circumcision is so newborns will match their father or brothers. About one in six boys and men in the world has been circumcised, in most cases for religious reasons. URINARY INFECTIONS Circumcised (29,217 boys) [left column] Uncircumcised (29,217 boys) [right column] Hospital Cumulative Hospital Cumulative infection rate infection rate Age admissions (per 1,000) admissions (per 1,000) [circ'd] [uncirc'd] 1 month 10 0.34 45 1.54 2 months 22 0.75 95 3.25 3 months 30 1.08 126 4.31 6 months 42 1.44 172 5.89 9 months 51 1.75 192 6.57 1 year 55 1.88 205 7.02 3 years 84 2.96 247 8.75 The Lancet, Dec. 5, 1998 Copyright c Southam Inc. All rights reserved. Optimized for browser versions 3.0 and higher. "National Post Online is a production of Southam Inc., Canada's largest publisher of daily newspapers."
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