Association Between Male Circumcision and Cervical Cancer Risk: A Systematic Review and Meta-Analysis of Analytical Studies
PURPOSE
Cervical cancer is the second most commonly diagnosed cancer and one of the leading causes of death in women. The objective of the current review was to synthesize the available evidence on the association between male circumcision and risk of cervical cancer in females.
METHODS
We searched PubMed, Cochrane, CancerLit, Google Scholar, medRxiv, bioRxiv, UpToDate, TRIP database, and the ProQuest Dissertations and Theses Global databases to identify relevant articles. We considered research studies that assessed male circumcision status and cervical cancer in females for inclusion. The risk-of-bias assessment was performed using the Newcastle-Ottawa scales. We estimated summary measures of effect and 95% CIs for the odds of developing cervical dysplasia, carcinoma in situ, or invasive cervical cancer in females based on the circumcision status of their male partners.
RESULTS
We identified 380 potentially eligible records through systematic database searches. After excluding 278 records on the basis of title and abstract screening, 102 full-text records were assessed for eligibility. We included 19 studies in the final analysis. The risk-of-bias assessment revealed a low risk across 10 records. Male circumcision was associated with decreased odds of cervical cancer (odds ratio [OR], 0.65 [95% CI, 0.53 to 0.79]). Circumcision was also associated with decreased odds of developing Invasive cervical cancer (OR, 0.71 [95% CI, 0.51 to 0.99]), cervical dysplasia (OR, 0.65 [95% CI, 0.45 to 0.92]), and carcinoma in situ cervix (OR, 0.67 [95% CI, 0.50 to 0.90]).
CONCLUSION
Male circumcision has been found to be associated with lower odds of developing various cervical lesions, suggesting its prophylactic potential. Understanding the effects of male circumcision on human papillomavirus (HPV) infection would have important implications for studies of HPV transmission, leading to a better understanding of the pathogenesis of cervical cancer.