Decline in circumcisions could cost billions

Posted at 12:56 PM, Aug 21, 2012
and last updated 2012-08-21 14:56:04-04

By Matt Sloane

(CNN) — As the number of American parents increasingly leave their baby boys uncircumcised, HIV and other sexually transmitted disease rates are likely to climb, according to researchers from Johns Hopkins University, and the costs associated with those diseases could reach into the billions.

“The medical benefits of male circumcision are quite clear,” said Dr. Aaron Tobian, an assistant professor of pathology at Johns Hopkins and lead author of the study published Monday in the Archives of Pediatric and Adolescent Medicine. “But while the medical evidence has been increasingly more positive, male circumcision rates in the U.S. have been decreasing.”

Specifically, he says, circumcision rates had been fairly stable in the 1970s, at about 79%. By 1999, he says less than 63% of boys had the procedure, and by 2010, the rate had dropped to 55%.

What’s more, state-run and private insurance companies in at least 18 states have dropped coverage for male circumcision – a procedure that can cost between $250 and $300 without insurance coverage, causing even more parents to pass on the procedure for male infants.

“If circumcision rates decrease to 10% – the levels seen in Europe where insurance coverage is limited – the direct medical costs associated with that drop could exceed $4 billion,” said Tobian.

That added cost, he says, is largely from an increase in HIV infections and human papillomavirus (HPV)-related cancers he believes would result from the drop in circumcisions.

“Three randomized trials have demonstrated that male circumcision decreases HIV, male herpes, and HPV — the virus that causes cervical and penile cancer,” Tobian said. “As male circumcision rates increase, you decrease HIV acquisition among men. Later down the road, because fewer men are infected, you’d have less transmission.”

As a result of this study, Tobian says he’s calling on the American Academy of Pediatrics, other advocacy groups and insurance companies to pave the way for more circumcisions.

“We should eliminate all of the current barriers that are in the way of individuals receiving this procedure,” he said. “Once we do that, families can discuss the risks and the benefits of having the procedure with their physicians, and then can make an informed decision.”

The American Academy of Pediatrics is expected to release an updated position paper supporting the health benefits of male circumcision by the end of this month.

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