Evidence Favors Male Circumcision, But Parents Still Must Choose, Says AAP

According to the American Academy of Pediatrics (AAP), the latest evidence shows (4-page PDF; About PDFs) the benefits of newborn male circumcision outweigh the risks.

The AAP, in an updated policy statement published Aug. 27 in Pediatrics, said that a multidisciplinary panel evaluated the evidence and determined that circumcision's benefits -- prevention of urinary tract infections, penile cancer and transmission of some sexually transmitted infections, including HIV -- justify access to the procedure (i.e., health insurance coverage) for families who choose it.

Previously, the AAP did not recommend for or against the procedure, citing insufficient evidence to make a determination in its earlier policy, which was published in 1999 and reaffirmed in 2005.

According to Susan Blank, M.D., chair of the AAP's statement and technical report task force, recent scientific research shows clearer health benefits to the procedure than had been demonstrated previously, but the choice still rests with parents.

"Ultimately, this is a decision that parents will have to make," Blank said in an AAP press release. "Parents are entitled to medically accurate and nonbiased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs."

The AAFP Commission on Health of the Public and Science's Subcommittee on Clinical Practice Guidelines will review the update, as well as the accompanying technical report, in the coming months. Family physician Lesley Atwood, M.D., served as the AAFP's liaison to the AAP task force.

The Academy's position paper on neonatal circumcision, which was updated in 2007, does not recommend for or against the procedure and states that although the literature available at the time was "conflicting or inconclusive," the decision whether or not to circumcise generally comes down to nonmedical preferences. Therefore, physicians should discuss the potential harms and benefits of newborn male circumcision with all parents or legal guardians considering the procedure.

The AAP's shift in position may strengthen circumcision proponents' call to reverse the steadily declining rates of infant male circumcision in the United States. An Aug. 20 report in the Archives of Pediatrics & Adolescent Medicine indicates that circumcision rates have declined from 79 percent to 55 percent in the past two decades -- a drop that has coincided with reduced insurance coverage for the procedure.

Eighteen states currently do not provide Medicaid coverage for infant circumcision, and private third-party payers also are decreasing coverage, the study notes.

According to a release that accompanied the study, if this trend continues and rates decline to European levels, net present value of additional health care expenditures in the United States would exceed $4.4 billion in the next 10 annual birth cohorts.

The study, which indicates that the added expenses stem from higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partners, estimates that the current decline already has cost the United States more than $2 billion.

"Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear," said Aaron Tobian, M.D., Ph.D., senior study investigator and health epidemiologist and pathologist at the Johns Hopkins University School of Medicine in Baltimore. "There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well."