Most readers will know that human papillomavirus (HPV) testing replaced the Pap smear on 1 December 2017, but few will be aware that, like HPV vaccination, the HPV test had an Australian origin.

The HPV test was invented by Dr Brian Nightingale and myself in the 1980s. We then patented it with the priority date of 26 February 1987. Our test involved the first application of a gene mutation detection technique – the polymerase chain reaction – to viral detection. Roche recognised our international priority position and covered the University of Sydney’s patenting costs in exchange for an option on the technology.

Patents only last 20 years. As a result, our patent expired a decade ago. Nevertheless, I continued to press the case for HPV testing because of its superiority over the antiquated Pap smear. With business associates, I helped launch the company TamPap in Australia in 2007. This involved women collecting their own sample using a tampon and mailing it to a laboratory for HPV testing. With Dr Christian Jessen (known for TV shows ‘Embarrassing Bodies’ and ‘Dr Christian Will See You Now’), we launched TamPap in the UK in 2009. To this day, I continue to assist Australian industry in the roll-out of a self-sampling at home approach, as this modality is a valuable adjunct to clinic-based screening for underscreened women.

It has been a long road, but I am thrilled that, after early resistance, the Australian Government has finally embraced HPV testing. It will more accurately inform women whether they are infected with the virus that is almost always the cause of cervical cancer. As a result, more women will be spared the prospect of getting cervical cancer, a devastating disease that can strike women at a critical time in their child-rearing life.

The Government’s plan involves women visiting their doctor, who will take a sample in the same way as for a Pap smear and send it off to a lab for HPV testing. Women who are currently underscreened will be encouraged to self-sample. This may include Aboriginal and Torres Strait Islander women in remote regions lacking medical services and women in religious minority groups who find sampling by a doctor unacceptable. At the same time, several private labs are making various kits available whereby a woman can collect her own sample and mail it to the lab for testing. I have been helping with this endeavour.

Cervical screening was a new direction for me. While I am a molecular biologist, my research has always focused on unravelling the cause of the major killer disease, hypertension, for which I have been fortunate enough to receive major international awards for my research and was made a member of the Order of Australia in this year’s Queen’s Birthday Honours. When I entered the HPV field, I quickly became aware of the general cervical cancer field and risk factors for this devastating cancer.

HPV is a sexually transmitted infection (STI). It has long been recognised that women with uncircumcised male partners are at much higher risk of cervical cancer. In 1989, a large study in Nairobi, Kenya, linked heterosexual HIV infection in men to lack of circumcision. By chance, I was attending a hypertension conference in Nairobi at the time. During a safari after the conference, our tour group came upon some Maasai boys dressed in dark ceremonial robes, white face paint and a head dress of white feathers. I asked the tour guide about the significance of the razor blade each boy was wearing as a pendant around their neck. He said it was the instrument used for their circumcision. I learned that many tribes perform circumcision of boys during their coming-of-age rituals. That was significant because an enormous body of research has discovered that tribes that circumcise boys have much lower HIV prevalence. Almost two decades later, three large randomised clinical trials confirmed the strong protective effect of circumcision against heterosexual HIV infection by men, as well as HPV and other STIs.

It intrigued me that male circumcision had these kinds of benefits to men and women. I shared this news with my academic colleagues. It wasn’t long before I was asked by a medical graduate, who was undertaking a PhD in my department, to give a seminar on circumcision for STI prevention to a group of doctors. My knowledge at the time was rudimentary, so I had to do an extensive literature review in preparation for my talk. The talk went well. So much so that they asked me to write it up for publication in their newsletter. I then decided to put the information up as a website. That site (www.circinfo.net) has grown enormously over the years, as have my contributions to medical literature on the topic of male circumcision. I now have 100 academic publications on the topic.

The enormous benefits of infant male circumcision have resulted in it being recommended by the American Academy of Pediatrics in its latest policy statement in 2012 and by the Centers for Disease Control and Prevention in the US. In Australia, I was present at a meeting in 2010 at the National Centre in HIV Epidemiology and Clinical Research (now the Kirby Institute) which led to the formation of the Circumcision Academy of Australia (www.circumcisionaustralia.org). The Academy published an affirmative policy statement on male circumcision in 2012 (see website). The Royal Australasian College of Physicians (RACP) has lagged behind in developing an evidence-based infant male circumcision policy, but hopefully that will change soon. If this is based on the current strong medical scientific evidence, the RACP will likely recommend newborn male circumcision as a very low-risk intervention for protection against urinary tract infections, physical problems, penile inflammatory conditions, various STIs, thrush, inferior hygiene, penile cancer and prostate cancer in men, and reduction in STIs and cervical cancer in women.

Together, HPV testing and an upsurge in male circumcision in Australia will help further reduce cervical cancer. Vaccination of girls and boys early in high school will also make a major contribution to a reduction in HPV. It should, however, be recognised that neither of these strategies alone will be 100 per cent effective. All strategies need to be put in place if effectiveness of cervical cancer reduction programs is to be maximised.

Patent

Morris BJ, Nightingale BN. (1987) A Method of Detection of Carcinogenic Papillomavirus. US Patents No. 5,783,412 and 6,218,104; European Patent No. 88902077.2-2107 (British, 0357611; German, 3853678.1; Swiss, 3853678.1; Swedish, 0357611), Japanese Patent No. 3096704; Australian Patent No. 611135. Priority date: 26 Feb 1987.

Further reading

• Morris BJ, Rose BR. Cervical screening in the 21st century: the case for human Papillomavirus testing of self-collected specimens. Clinical Chemistry and Laboratory Medicine 2007;45:577-91.
• Morris BJ, Kennedy SE, Wodak AD, et al. Early infant male circumcision: systematic review, risk-benefit analysis and progress in policy. World Journal of Clinical Pediatrics 2017;6:89-102.