Circumcision and cervical cancer. Is there a link?

penile human papillomavirus infection, and cervical cancer in female partners. Research question Does circumcision reduce the risk of penile human papillomavirus (HPV) infection in a man and cervical cancer in his female partner? Type of article and design Seven case-control studies. Relevance to family physicians We are often asked by new parents about the benefi t and harm of male circumcision. Some studies have suggested that circumcision reduces risk of urinary tract infections, penile cancer, and HIV infection. Poor cosmetic results, removing too much or too little foreskin, or uneven removal of the foreskin are potential adverse outcomes; occasionally circumci-sion results in meatal stenosis. 1 Despite the reported benefi ts of circumcision, the most common reason for doing it is that the father was circumcised. 2 There is much literature on male circumcision, and several medical organizations have published policy statements on the topic. The Canadian Paediatric Society does not recommend routine neo-natal circumcision 2 nor does the American Academy of Pediatrics 3 or the American Academy of Family Physicians. 4 An interesting website, Circumcision Information and Resource Pages (www.cirp.org) provides the policy statements of English-speaking countries and extensive references for physicians and parents. Non–English-speaking nations have no policy on the subject because they do not routinely circumcise male infants. In Canada, it is estimated that 48% of men have been circumcised , 2 but it is difficult to get accurate statistics because almost no health insurance plans in Canada pay for circumcision any longer. In the United States, 61% pay; 1 in Australia, 70% pay; 2 and in the United Kingdom, 24% pay. 2 While circumcision is the most commonly performed surgical procedure in the United States, 1 it is uncommon in northern European countries, Central and South America, and Asia. Human papillomavirus is not currently under systematic surveillance in Canada, so its prevalence is unknown. 5 In the United States, an estimated 5.5 million people become infected with HPV each year, and an estimated 20 million are currently infected. 6 Is there new evidence that will help guide Canadian family physicians and parents in decisions about neonatal circumcision? Over view of study and outcomes Seven case-control studies, five involving invasive cervical cancer and two involving cervical carcinoma in situ, looked at data on 3790 women to evaluate a connection between circumcision and HPV in men and cer vical cancer in their female partners. The studies were conducted in …