PEDIATRICS Vol. 108 No. 1 July 2001, pp. 211

Reply to Carole M. Lannon and the Task Force on Circumcision

To the Editor.

In their response to our criticisms of the Task Force on Circumcision findings,¹ Lannon et al² continue to downplay the strength of available evidence regarding the benefits of male circumcision. Multiple publications contribute to the increasing and compelling evidence of the potential health benefits of circumcision.^3-8 These benefits reflect the considerably higher risks of penile cancer,⁴ urinary tract infections,^6,8 penile skin disorders,⁷ and human immunodeficiency virus transmission^3,5 among uncircumcised men. The rates of penile cancer and urinary tract infections reported in these recent studies are considerably higher than those put forth in the Task Force statement and reflect earlier estimates. Although not yet published at the time of the Task Force statement, this new evidence is consistent with the large body of evidence available to the Task Force but largely ignored in their conclusions.

Our remarks are not meant to represent an overzealous procircumcision stance. Instead, we argue that the best available scientific evidence should be presented to individuals and families to enable them to make an informed choice. Modern pediatric practice supports such nondirectional counseling. Informed persons may then conclude, as do Lannon et al,² that the multiple medical conditions prevented by neonatal circumcision are not sufficiently important to warrant the procedure. However, the choice should be based on an accurate presentation of scientific evidence, which we believe was not provided in the Task Force report.

	ACKNOWLEDGMENT

The Medical Editing Department, Kaiser Foundation Research Institute, provided editorial assistance.

Edgar J. Schoen, MD
Department of Pediatrics and Genetics
Kaiser Permanente Medical Center
Oakland, CA 94611-5693

Thomas E. Wiswell, MD
Department of Pediatrics and Neonatology
Thomas Jefferson University
Philadelphia, PA 19107

Stephen Moses, MD
Department of Medical Microbiology
Community Health Sciences and Medicine
Basic Medical Sciences Building
University of Manitoba
Winnipeg, Manitoba, Canada R3E OW3

REFERENCES

1. Schoen EJ, Wiswell TE, Moses S New policy on circumcisioncause for concern. Pediatrics. 2000; 105:620-623 [Free Full Text]
2. Lannon CM, Bailey A, Fleischman A, Kaplan G, Shoemaker C, Swanson J, Circumcision debate. Pediatrics. 2000; 105:641-642 [Free Full Text]
3. Halperin DT, Bailey RC Male circumcision and HIV infection: 10 years and counting. Lancet. 1999; 354:1813-1815 [CrossRef][Medline]
4. Schoen EJ, Oehrli M, Colby CJ, Machin G. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics. 2000;105(3). Available from: URL: http://www.pediatrics.org/cgi/content/full/105/3/e36
5. Quinn TC, Wawer MJ, Sewankambo N, Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med. 2000; 342:921-929 [Abstract/Free Full Text]
6. Schoen EJ, Colby CJ, Ray G Newborn circumcision decreased incidence and costs of urinary tract infections during the first year of life. Pediatrics. 2000; 105:789-793 [Abstract/Free Full Text]
7. Mallon E, Hawkins D, Dinneen M, Circumcision and genital dermatoses. Arch Dermatol. 2000; 136:350-354 [Abstract/Free Full Text]
8. Wiswell TE The prepuce, urinary tract infections, and the consequences. Pediatrics. 2000; 105:860-862 [Free Full Text]