Circumcision benefits outweigh disadvantages
A new policy statement issued by the American Academy of Pediatrics and backed by the American College of Obstetricians and Gynecologists states that the health benefits of circumcision in newborn males outweigh any risks and insurance companies should pay for it.1
While the policy statement recognizes the medical benefits of the procedure, it stops short of recommending routine circumcision for all newborn males. The revised statement follows in the same vein as the previous document in saying that the decision to circumcise should be left to the parents in consultation with their child's physician.
"Ultimately, this is a decision that parents will have to make," said Susan Blank, MD, FAAP, American Academy of Pediatrics chair of the circumcision task force, in a press statement accompanying the publication. "Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical, and cultural beliefs."
Three randomized clinical trials, considered the gold standard of medical evidence, demonstrate that male circumcision decreases HIV, genital herpes, and human papillomavirus, which causes penile cancer, says Aaron Tobian, MD, PhD, assistant professor of pathology at John Hopkins University.2-6 In addition, there are benefits for female partners of circumcised men, with reduced levels of cervical cancer, bacterial vaginosis, and trichomoniasis, he notes.7-8
While the body of medical evidence supporting male circumcision continues to increase, the rate of procedures continues to decrease, Tobian notes. While the prevalence of U.S. male infant circumcision remained steady at about 79% during the 1970s and 1980s, rates have been dropping, reaching 54.7% by 2010.9
Declining insurance coverage for male circumcision has been an important factor in the lowered number of procedures, notes Tobian. Not only are fewer private payers offering coverage, but state Medicaid funding cuts have made their mark, says Tobian. In 2011, Colorado and South Carolina joined 16 other states in dropping coverage for infant male circumcision. (See box, below, for list of states.) State Medicaid plans cover two-fifths of all births in the United States.10
| No Medicaid Coverage for Male Circumcision | |
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Source: Walker AK. Which states don't cover circumcision? Baltimore Sun; Aug. 21, 2012. Accessed at http://bit.ly/U4DaBz. |
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In a new cost analysis, Tobian and other investigators at Johns Hopkins University in Baltimore estimate an additional $4.4 billion in avoidable healthcare costs will occur if U.S. male circumcision rates continue to decline.11 The added expense stems from new cases and higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners, the analysts conclude.
Data informs change
Two barriers — financial and informational — have deterred circumcision, says Tobian. With the American Academy of Pediatrics moving forward with its revised policy statement, both barriers have begun to be addressed, he notes.
"Clearly, they are trying to tell physicians and parents that there are true medical benefits to male circumcision," said Tobian. "[They] also made it very clear, even in their abstract, that the benefits outweigh the risks and all insurance carriers, including state government, should cover this procedure."
Research indicates that male circumcision is safest and offers the most health benefits if performed during the newborn period. By removing the two barriers to the procedure, Tobian believes progress will begin to be made in increasing male circumcision levels.
"I think over the next couple of decades, you will likely see the rates of male circumcision stay steady or increase, instead of the decrease we've seen over the last 20 years," he notes.
References
- Task Force On Circumcision. Circumcision policy statement. Pediatrics 2012; 130(3):585-586.
- Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Medicine 2005; 2:e298.
- Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369(9562):643-656.
- Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007; 369(9562):657-666.
- Gray RH, Serwadda D, Kong X, et al. Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: a randomized trial in Rakai, Uganda. J Infect Dis 2010; 201(10):1,455-1,462.
- Tobian AA, Serwadda D, Quinn TC, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. NEJM 2009; 360(13):1,298-1,309.
- Gray RH, Kigozi G, Serwadda D, et al. The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda. Am J Obstet Gynecol 2009. Doi: 10.1016/j.ajog.2008.07.069.
- Wawer MJ, Tobian AA, Kigozi G, et al. Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda. Lancet 2011;377(9761):209-218.
- Centers for Disease Control and Prevention (CDC). Trends in in-hospital newborn male circumcision — United States, 1999-2010. MMWR 2011; 60(34):1,167-1,168.
- Walker AK. Which states don't cover circumcision? Baltimore Sun; Aug. 21, 2012. Accessed at http://bit.ly/U4DaBz.
- Kacker S, Frick KD, Gaydos CA, Tobian AR. Costs and effectiveness of neonatal male circumcision. Arch Pediatr Adolesc Med 2012. Doi:10.1001/archpediatrics.2012.1440.
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