Evidence that male circumcision has health benefits is growing, even as the quick but often-controversial surgery becomes less common in the United States, say medical experts making new efforts to publicize the benefits.
In a study out Monday, researchers say falling infant circumcision rates could end up costing billions of U.S.health care dollars when men and their female partners develop AIDS and other sexually transmitted infections and cancers that could have been prevented.
Separately, the American Academy of Pediatrics is about to issue a new policy statement that says infant circumcision has “significant” health benefits, replacing a statement that takes a more neutral stance.
“We have a tremendous amount of information coming out about the benefits of male circumcision,” says Aaron Tobian, a researcher at the Johns Hopkins University School of Medicine who is among the authors of the cost study.
But rates among U.S. infants have dropped since the 1970s and are likely to keep dropping if more insurers follow 18 state Medicaid programs that have stopped covering the procedure, says the report from Tobian and his colleagues, published in theArchives of Pediatrics & Adolescent Medicine.
The researchers say that if U.S. rates dropped to 10% — the level seen in European countries where insurers don’t cover circumcision — the results would include:
•211% more urinary tract infections in baby boys.
•12% more HIV cases in men.
•29% more human papillomavirus (HPV) cases in men.
•18% more high-risk HPV infections in women.
The fallout also would include more cases of cervical and penile cancer linked to HPV, but the highest costs would be associated with HIV, the virus that causes AIDS, the researchers say. Each skipped male circumcision would end up costing $313 in direct medical bills, and the total cost over a decade could exceed $4 billion, they say.
The estimates are based largely on a recent study in Uganda in which men underwent circumcision — a surgery that removes the foreskin on the penis — or remained uncircumcised and then were followed, along with their female partners. Three such “gold-standard” randomized trials in Africa now back up observational studies around the world, including in the United States, Tobian says.
The same evidence is behind the new statement by the pediatrics group, says Michael Brady, an expert in infectious disease at Nationwide Children’s Hospital in Columbus, Ohio. He is on the committee writing the new statement and says the revision is likely to be published online in September.
“We are going to say there is now reasonable evidence of benefit. And there are certainly some risks,” including bleeding, infection and pain, which the group will make clear should be well controlled, Brady says. “We are going to try to make sure people are educated on the risks and benefits and say that the decision should be based on what the family feels is the best interest of the child.” Insurers should cover the surgeries, he says. Religious and cultural differences must also be respected, he adds.
But some activist groups oppose infant circumcision, even for children from families who practice it as a religious rite, because they say it is an unneeded surgery that violates babies’ rights. “We believe in protecting all babies,” says Georganne Chapin, executive director of one such group, Intact America.
Chapin questions the studies finding health benefits and cites other studies that do not, but she says parents should let boys grow up and make their own choices. “We don’t let parents chop off other healthy body parts.”
The World Health Organization says that while circumcision is safe for adults, they heal more slowly and have more complications than babies do.
USA Today, Kim Painter. For original article, click here.
J. Kyle Mathews, MD