Benm schreef:
De wereld uit is altijd een verhaal van de lange adem. Maar nederland of west-europa uit ligt een stuk minder complex.
Gezien de lage prevalentie van HIV en de brede beschikbaarheid van condooms en dergelijke is er m.i. geen valide argument om het te doen, ook al zou het de besmettingskans met 65% verminderen. In nederland sterven op jaarbasis ongeveer 50 mensen door de gevolgen van HIV/aids, en daarvan heeft nog een flink deel het via niet-sexuele wijze (naalden van drugsgebruikers etc, bloedtransfusies uit een ver verleden etc) opgelopen.
Jaarlijks worden in nederland ongeveer 90.000 jongens geboren. Gezien het beide jaarlijkse cijfers zijn zou je dus pakweg 1800 kinderen moeten besnijden om er 1 te redden, en dat is aangenomen dat alle gevallen van hiv besmetting sexueel zijn, en besnijdenis infectie met 100% garantie voorkomt. Reken je met 65% (wat ik niet plausibel vind, maar goed) dan loopt het richting de 3000. Als je ook nog kijkt naar niet-sexuele overdracht van hiv, en mogelijk behandeling die voorkomt dat iemand eraan sterft, dan loopt dit getal nog veel verder op..
Bs'd
Aantal Nederlandse hiv-geïnfecteerden neemt toe met 1100 per jaar
http://www.volkskrant.nl/vk/nl/2672/Wetenschap-Gezondheid/article/detail/3545372/2013/11/15/Aantal-Nederlandse-hiv-geinfecteerden-neemt-toe-met-1100-per-jaar.dhtml
Twee derde daarvan zijn homoseksuelen, dus zo'n 350 per jaar worden in NL door heteroseks besmet per jaar. In alle gevallen geeft een behoorlijke vermindering van de levensverwachting, en een sterke vermindering van de kwaliteit van het leven. door het altijd moeten slikken van zware medicatie, en het niet meer kunnen hebben van een normaal seksleven.
Met een beschermingsfactor van 65% kan de besnijdenis dus zo'n 200 infecties per jaar verminderen, dat betekent dan volgens jouw berekening dat je 450 jongetjes moet besnijden om 1 HIV infectie te voorkomen.
Levenslange HIV remmers kunnen tot meer dan een half miljoen euro kosten, en 750 besnijdenissen kosten ongeveer 150.000 euro. Tel uit je winst.
En dan hebben we het natuurlijk alleen nog maar over AIDS. Laten we het nu eens over kanker gaan hebben. Besneden mannen zijn ongeveer 50% minder vaak besmet met het HPV virus, wat o.a. peniskanker, baarmoederhalskanker, en prostaatkanker veroorzaakt. Peniskanker en baarmoederhalskanker zijn redelijk zeldzaam, maar prostaatkanker staat voor 27% van de nieuwgevonden kankers in mannen. De besparingen in menselijk lijden, dood, en geld die in deze door de besnijdenis bespaard wordt is enorm.
Hier wat uittrekstels over onderzoeken hierover:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668781/
The genital cancer for which infant male circumcision confers the greatest protection is cancer of the penis, a disease that is confined almost exclusively to uncircumcised men (
Larke et al., 2011;
Morris et al., 2011). Meta-analyses have confirmed findings of previous epidemiological studies, suggesting that phimosis, balanitis and the presence of smegma increase the risk of penile cancer by 12-, 4- and 3-fold, respectively (
Morris et al., 2011). Each of these risk factors is either more common in, or exclusive to, uncircumcised men. Inflammation is a predisposing factor for many cancers, further supporting evidence that balanitis, defined as inflammation of the foreskin and head of the penis, may increase penile cancer risk (
Chaux and Cubilla, 2012).
A randomised controlled trial (RCT) showed that male circumcision provides 98% protection against the acquisition of flat penile lesions caused by a multitude of oncogenic HPV genotypes such HPV56 (29%; a type not targeted by vaccines), HPV16 (26%) and others that were less common (
Backes et al., 2012). A meta-analysis of 21 observational studies and two RCTs has, moreover, shown that circumcision reduces by 43% and 33%, respectively, the risk of genital infection by high-risk HPV in men (
Bosch et al., 2009). Circumcision affords 57% protection against high-risk HPV16 acquisition in men who predominantly practice insertive anal intercourse (
Poynten et al., 2012). RCT data showed a 95% reduction in the viral load of high-risk HPV types 24 months after circumcision, and a 46% reduction in high-risk HPV signal strength
Asian Pacific journal of cancer prevention : APJCP
Author Manuscript
NIH Public Access
Should Male Circumcision be Advocated for Genital Cancer Prevention?
Brian J Morris, Adrian Mindel, [...], and Alex D Wodak
Additional article information
Abstract
The recent policy statement by the Cancer Council of Australia on infant circumcision and cancer prevention and the announcement that the quadrivalent human papillomavirus (HPV) vaccine will be made available for boys in Australia prompted us to provide an assessment of genital cancer prevention. While HPV vaccination of boys should help reduce anal cancer in homosexual men and cervical cancer in women, it will have little or no impact on penile or prostate cancer. Male circumcision can reduce cervical, penile and possibly prostate cancer. Promotion of both HPV vaccination and male circumcision will synergistically maximize genital cancer prevention.
Keywords: Cancer, men’s health, women’s health, infectious diseases, public health, sexual health, urology
Introduction
The Cancer Council of Australia recently issued a policy statement entitled “Neonatal male circumcision and cancer” that addresses penile cancer and prostate cancer, concluding that it “does not recommend circumcision as a routine cancer-preventive procedure at this time” (
Cancer Council of Australia, 2012). This policy was based on the infant circumcision policy of the
Royal Australasian College of Physicians (2010) that ignored much of the compelling evidence concerning the medical benefits of male circumcision (
Morris et al., 2012a). The
American Academy of Pediatrics (2012) new policy statement and technical report concludes that the health benefits of male circumcision outweigh the risks. Here we evaluate the current evidence and provide additional information to convey a more complete assessment of the roles of male circumcision and HPV vaccines in reducing genital tract cancers in men and women.
Circumcision-related Cancer
The genital cancer for which infant male circumcision confers the greatest protection is cancer of the penis, a disease that is confined almost exclusively to uncircumcised men (
Larke et al., 2011;
Morris et al., 2011). Meta-analyses have confirmed findings of previous epidemiological studies, suggesting that phimosis, balanitis and the presence of smegma increase the risk of penile cancer by 12-, 4- and 3-fold, respectively (
Morris et al., 2011). Each of these risk factors is either more common in, or exclusive to, uncircumcised men. Inflammation is a predisposing factor for many cancers, further supporting evidence that balanitis, defined as inflammation of the foreskin and head of the penis, may increase penile cancer risk (
Chaux and Cubilla, 2012).
While it is clear that penile cancer is uncommon in the overall male population, with “an [annual population] incidence of 1 in 100,000”, to quote the
Cancer Council of Australia (2012) policy statement, the lifetime prevalence – 1 in 1,000 in uncircumcised men (
Morris et al., 2011;
American Academy of Pediatrics, 2012) – provides a more realistic picture.
A randomised controlled trial (RCT) showed that male circumcision provides 98% protection against the acquisition of flat penile lesions caused by a multitude of oncogenic HPV genotypes such HPV56 (29%; a type not targeted by vaccines), HPV16 (26%) and others that were less common (
Backes et al., 2012). A meta-analysis of 21 observational studies and two RCTs has, moreover, shown that circumcision reduces by 43% and 33%, respectively, the risk of genital infection by high-risk HPV in men (
Bosch et al., 2009). Circumcision affords 57% protection against high-risk HPV16 acquisition in men who predominantly practice insertive anal intercourse (
Poynten et al., 2012). RCT data showed a 95% reduction in the viral load of high-risk HPV types 24 months after circumcision, and a 46% reduction in high-risk HPV signal strength in type-specific linear array quantitative polymerase chain reaction assays (
Wilson et al., 2012).
The vaccination of girls with the quadrivalent HPV vaccine in Victoria, Australia that began in 2007 has already been associated with a very small (0.38%) reduction in the high-grade lesions that can precede cervical cancer (
Brotherton et al., 2011). The recent announcement that the program will be extended to boys should, with time, further lower common low-risk and high-risk HPV types in both sexes, and anal cancer in men who have sex with men. However, although high-risk HPV has been implicated in over 99% of cervical squamous cell carcinomas (SCC), its presence in penile SCC varies by histological type and it is found on average in only 50% of SCCs (
Mirralles-Guri et al., 2006). Moreover, oncogenic types not presently covered by current HPV vaccines can be common (
Mirralles-Guri et al., 2006;
Larke et al., 2011;
Morris et al., 2011). Based on an assumption drawn from cervical SCC (
Bosch et al., 2009;
Morris et al., 2011)) of a 70% prevalence of high-risk HPV vaccine types 16 and 18 in the 50% of penile cancers that do contain HPV, we estimate that vaccination, under the most optimistic of scenarios, could reduce penile cancer by up to 35%. In vulval intraepithelial neoplasia (VIN) the prevalence of HPV is likewise approximately 50%, the effectiveness of the quadrivalent HPV vaccine in reducing HPV-related disease having been found to be 18.4% for VIN grade I or worse and 23.5% for VIN grade II or worse (
Joura et al., 2012).
In summary, penile cancer is certainly uncommon though not rare and it occurs almost exclusively in uncircumcised men. Men who are circumcised are protected against multiple foreskin-related risk factors and are less likely to acquire oncogenic HPV infections. Given the mixed array of etiological factors, HPV vaccines are likely to have only a partial effect in reducing penile cancer incidence.
Cervical cancer, which still affects 700 women and causes 200 deaths in Australia every year (
Canfell et al., 2006;
Australian Institute of Health and Welfare, 2011), is less common in female sex partners of circumcised males (
Albera et al., 2012), making circumcision worthy of consideration. In a RCT, female partners of circumcised men had a 28% lower prevalence of high-risk HPV compared to female partners of uncircumcised men (
Wawer et al., 2011). This may be explained by the decreased penile high-risk HPV shedding observed among infected circumcised men (
Wilson et al., 2012). A large study in the New England Journal of Medicine found that the risk of cervical cancer in monogamous women whose male partner had had 5 or more previous sexual partners was 6-fold lower when their male partner was circumcised, and was 2-fold lower for female partners of circumcised males with an intermediate sexual behaviour risk index (
Castellsague et al., 2002). Risk reduction was also reported in a meta-analysis of 14 studies (
Albero et al., 2012) and a recent European study of 3,261 women found that in women with two or more lifetime sexual partners, male circumcision was associated with a 40% lower risk of HPV (Rora et al., 2011). Condoms offered only slight protection (
Castellsague et al., 2002;
Wawer et al., 2011; Rora et al., 2011). The quadrivalent HPV vaccine was found to reduce cervical intraepithelial neoplasia (CIN) grade I or worse by 46.3% and CIN II or worse by 40.8% (
Joura et al., 2012). While prophylactic HPV vaccines should reduce cervical cancer incidence and deaths, they do not cover the full spectrum of oncogenic HPV types. In contrast, circumcision partially protects against all oncogenic HPV types (
Wawer et al., 2011). Circumcision and vaccination should therefore be seen as synergistic interventions.
Cancer of the prostate is one of the most common cancers in men. A recent large study in Seattle showed a 12–18% reduction in prostate cancer in men circumcised in childhood compared to uncircumcised men (
Wright et al., 2012). The study also found that there was no significant reduction in prostate cancer associated with circumcision performed after sexual debut. The protective effect was not affected by socioeconomic status. These new findings add to numerous previous studies that have shown a 30–50% lower prevalence of prostate cancer in circumcised men (
Morris et al., 2007;
2011). Although a history of sexually transmitted infections is a risk factor, the evidence does not support a role for HPV infection (
Morris et al., 2007;
2011;
Wright et al., 2012). We agree with the Cancer Council of Australia that “more research is needed before there is sufficient evidence to recommend population-level circumcision to help reduce prostate cancer incidence” (
Cancer Council of Australia, 2012).
http://www.ncbi.nlm.nih.gov/pubmed/17935209
Why circumcision is a biomedical imperative for the 21(st) century.
Morris BJ.
Author information
Abstract
Circumcision of males represents a surgical "vaccine" against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain-free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio-sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals.
(c) 2007 Wiley Periodicals, Inc.
PMID:
17935209
[PubMed - indexed for MEDLINE]
De ethische kwestie wordt dan of het verantwoord is om minimaal 3000 mensen te mutileren om er eentje het leven te redden. Het antwoord daarop lijkt me eenduiding NEE, en besnijden van minderjarigen zonder medische noodzaak zou gewoon strafrechtelijk als mishandeling moeten worden afgedaan
Het lijkt me dat in een land waar tienduizenden ongeboren kinderen per jaar zonder verdoving door de abortustang aan stukken getrokken worden, dat daar niemand het woord "ethiek" in zijn mond moet nemen als het over de besnijdenis gaat. In elk geval niet iemand die niet fel tegen abortus is. Anders krijg ik braakneigingen.
En om het even in perspectief te zetten: In nederland sterven jaarlijks ongeveer 3000 vrouwen aan borstkanker, 60 keer meer dan er mensen aan aids sterven. Toch haalt geen medicus het in zn botte hoofd om te preventie bij alle meisjes de borsten te amputeren - en dat is maar goed ook.
Angelina Jolie heeft pas haar borsten laten verwijderen omdat ze bang was voor borstkanker. Dus zo gek is dat niet.
Maar je kan natuurlijk het verwijderen van een klein stukje vel niet gaan vergelijken met borstamputatie.
Dat is een totaal kolderieke vergelijking en een teken dat je zonder serieuze argumenten zit.
Het lijkt me bijzonder onethisch om een bewezen levensredder die goedkoop, veilig, en effectief is, geen bijwerkingen heeft, en levenslang werkzaam is, te gaan verbieden zonder enige goede reden. Alleen vanwege vooroordeel tegen religie.
Onderbuikgevoelens zijn niet zo belangrijk dat je er voor over lijken moet gaan.
roger, jij hebt in één zin mijn hele uitleg samengevat 
Puzzels
