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Uncircumcised Men Raise Partners' Cervical Cancer Risk

Male circumcision is linked with a reduced risk of both penile human papillomavirus infection and cervical cancer in women with high-risk sexual partners.

Probably the oldest surgical procedure in the world and still one of the most common, male circumcision has long been suspected of curbing risk of cervical cancer in female partners. However, the underlying reason was not clearly understood until certain types of human papillomavirus (HPV) were found to be implicated in the etiology of cancer of the cervix.

Now, a 15-year research project for the International Agency for Research on Cancer has culminated in convincing evidence that prevalence of HPV infection is reduced in circumcised men. The finding helps to clarify the male factor in causation of cervical cancer and provides a biologically plausible explanation for the overall excess risk of this cancer in the female partners of uncircumcised men.

Xavier Castellsague and colleagues from Spain pooled data on 1,913 couples enrolled in seven case-control studies of cervical carcinoma in situ and cervical cancer in five countries on three continents - Europe, South America and Asia.

The men in the study self-reported their own circumcision status and were medically examined at three of the study sites for the accuracy of their self-reports. Polymerase-chain-reaction assay was used to assess HPV DNA in 1,520 of the men, yielding a valid result for 1,139 (74.9 percent). Penile HPV was found in 166 of the 847 uncircumcised men (19.6 percent ) but in only 16 of the 292 circumcised men (5.5 percent).

After researchers accounted for the men's age at first intercourse, their lifetime number of sexual partners and other potential confounders, circumscribed men were found to be significantly less likely than were uncircumcised men to have penile HPV infection. This held true in the subgroup of men in whom physical examination confirmed the circumcision.

As for female partners of these men, monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than did women whose partners were uncircumcised.

Study authors suggest circumcision should thus be considered an important co-factor in the natural history of HPV infection, since it may influence the risks of acquisition and transmission of HPV as well as of cervical cancer. They also note their findings are consistent with those of other studies that male circumcision is linked with a reduced risk of human immunodeficiency virus (HIV) infection, penile cancer and a number of other common sexually transmitted disease.

Given the world wide effect of these diseases on public health, the study authors urge further study to determine if routine circumcision might reduce risks of HIV and HPV infections and other sexually transmitted diseases.

Now, about one man in four around the globe is likely to undergo circumcision. In the United States, an estimated 80 percent of all newborn boys were circumcised in the 1970s. Since then, however, rates have decreased.

Meanwhile, cervical carcinoma is one of the leading causes of death from cancer among relatively young women, particularly in developing countries.
N Engl J Med 2002;346:1105-12. "Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners"

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