Van Howe RS. Male circumcision and prostate cancer: A geographical analysis, meta-analysis, and cost analysis.
Can Urol Assoc J 2020;
14:E334-E340. [PMID:
32017694 PMCID:
PMC7337715 DOI:
10.5489/cuaj.6126]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 09/20/2023]
Abstract
INTRODUCTION
Attempts to find an association between male circumcision and prostate cancer risk have produced inconsistent results.
METHODS
Age-standardized prostate cancer incidence, life-expectancy, geographical region, and circumcision prevalence from 188 countries were compared using linear regression analysis. Following a systematic literature review, a meta-analysis was performed on studies meeting inclusion criteria with evaluations of between-study heterogeneity and publication bias. A cost analysis (discounted at 3% and 5% per annum) was performed using the meta-analysis's summary effect and upper confidence interval.
RESULTS
Univariate analysis revealed a trend for a positive association between country-level age-standardized prostate cancer incidence (per 100 000 person-years) and circumcision prevalence (β=0.0887; 95% confidence interval [CI)]-0.0560, +0.233), while multivariate analysis found a significant positive association (β=0.215; 95% CI 0.114, 0.316). Twelve studies were included in meta-analysis. The random-effects summary odds ratio of the risk of being genitally intact was 1.10 (95% CI 0.96, 1.26, between-study heterogeneity χ2 15=27.43; p=0.03; I2=82.8%). There was no evidence of publication bias. Cost analysis found infant circumcision was prohibitively costly, returning only between 1.6¢ and 13.8¢ for each dollar expended.
CONCLUSIONS
Circumcision may be a positive risk factor on geographical analysis, but not in case-case-controlled studies. Circumcision is not economically feasible for preventing prostate cancer.
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