Male Circumcision Cuts Women’s Cervical Cancer Risk
Study Shows Circumcision May Help Reduce Spread of HPV
By Salynn Boyles
Reviewed by Laura J. Martin, MD
Jan. 6, 2011 -- Circumcising men can reduce cervical cancer risk in women, a new study shows.
The study involved more than 1,200 HIV-negative, heterosexual couples living in Uganda, where circumcision of male adults is increasingly encouraged as a means of slowing the spread of HIV/AIDS.
Half the men received the surgical procedure at enrollment and the other half were scheduled for circumcision after their participation in the trial ended.
Two years later, the female partners of the men who remained uncircumcised were more likely than the partners of the circumcised men to be infected with human papilloma virus (HPV) types most often associated with cervical cancer.
In earlier trials, Johns Hopkins University researcher Aaron A.R. Tobian, MD, PhD, and colleagues showed that male circumcision reduces HIV infection, HPV in men, and genital herpes.
The new study appears online Friday in TheLancet.
"It is now clear that male circumcision can reduce HPV in females and possibly prevent cervical cancer in settings where HPV vaccines are not available," Tobian tells WebMD.
Circumcision Rate Drops in U.S.
The impact of circumcision on cervical cancer risk is less clear in the U.S. and other industrialized countries where cervical cancer screening is routine, says Anna Giuliano, MD, who chairs the department of cancer epidemiology at H. Lee Moffitt Cancer Center in Tampa, Fla.
But she adds that the recent research confirming circumcision's role in reducing the risk of HIV, HPV, and other sexually transmitted diseases are strong arguments in favor of the practice.
Neither the CDC nor the American Academy of Pediatrics (AAP) recommend routine circumcision of male infants, but the groups do not discourage the practice either.
New figures from CDC released in August confirm that fewer babies in the U.S. are being circumcised. Between 2006 and 2009, the circumcision rate among male newborns declined from 56% to 33%.
Both the CDC and the AAP are reportedly considering revisions to their infant circumcision policies in light of the new research.
The CDC is also considering whether circumcision should be recommended for adult men at high risk for HIV infection, according to a statement issued in August 2009.
It has been five years since the AAP last updated its infant circumcision policy, which calls the evidence regarding the impact of circumcision on sexually transmitted disease risk "complex and conflicting."
The studies by Tobian and colleagues were published after 2005, and Giuliano says the AAP policy statement should be changed to reflect the new research.
Circumcision Debate Emotionally Charged
But Giuliano does not believe policy makers for either group will take a strong stand in favor of male circumcision because the debate surrounding the practice is so emotionally charged.
In an editorial accompanying the study, she writes that new recommendations "should be consistent with the available evidence while considering other factors such as cultural and disease context, and the specific needs of different populations."
"Different cultures view circumcision in different ways, and there is a huge emotional component" she tells WebMD. "People in Latin America think of circumcision as barbaric. I have even heard this from colleagues in HPV prevention."
Circumcision is also not widely practiced in certain countries in Europe, but cervical cancer rates are very low in these countries because screening is common.
Cervical cancer rates are very high in countries like Mexico and Brazil, where neither circumcision nor screening is widespread.
She says in parts of Africa where circumcision is considered a rite of passage, the practice may make a big difference, especially in areas without access to the HPV vaccine.
SOURCES:Wawer, M.J. The Lancet, Jan. 7, 2011; online edition.Aaron A.R. Tobian, MD, PhD, assistant professor of pathology, Johns Hopkins University, Baltimore.Anna R. Giuliano, MD, chair, department of cancer epidemiology, H. Lee Moffitt Cancer Center, Tampa, Fla.News release, The Lancet.
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