We performed a quantitative review to evaluate circle hook use in recreational and commercial hook-and-line fisheries that interact with billfishes (Family: Istiophoridae). Specifically, we scrutinized the findings of 11 recent empirical studies that reported, on a species-specific basis, side-by-side measures of circle vs. J-hook fishing performance: catch, mortality, deep-hooking and bleeding rates. Of the 30 total comparisons extracted from the literature that satisfied our inclusion criteria, 13 indicated significant differences between hook types for the specific metric compared. No study reported significant billfish catch rate differences between hook types. However, when significant differences between hook types were found, higher mortality rates and higher rates of deep-hooking and bleeding were associated with J-hooks relative to circle hooks. We conclude that empirical evidence is sufficient to promote circle hook use in almost all hook-and-line fishery sectors that typically interact with istiophorids. However, billfish conservation benefits will only be realized if fishers use unmodified circle hooks, commit to releasing live fish and take other appropriate measures which maximize post-release survival. While there may be fishing modes where circle hook effects are negative, for billfish conservation, we recommend managers grant exceptions to circle hook use only when experimental results support such a practice.