Male circumcision, human papillomavirus and cervical cancer: from evidence to intervention.

©FSRH J Fam Plann Reprod Health Care 2009: 35(1) Introduction The relationship between male circumcision and genital human papillomavirus (HPV) infection and cervical cancer has been greatly clarified in recent years. Along with the strong evidence from both observational studies and three randomised clinical trials (RCTs) consistently showing that male circumcision reduces the risk of HIV infection,1–4 the rapidly accumulating evidence for a protective effect of male circumcision on HPV and cervical cancer has prompted the suggestion that male circumcision could be considered a major intervention measure to prevent the incidence of both diseases. Thus, the introduction of safe male circumcision, if widely accepted and implemented, might be in particular relevant in developing countries in which no other measures to curtail AIDS and cervical cancer are available. This commentary examines the evidence on the protective effect of male circumcision on penile HPV through a meta-analysis on the association between male circumcision and penile HPV and also summarises the authors’ own research data from a large multicentre casecontrol study that assessed the relationship between male circumcision and cervical cancer. Both pieces of evidence strongly suggest that male circumcision may indeed have an additional protective value against HPV and cervical cancer to the already established benefit for HIV prevention.