Understanding Anal Cancer Screenings

It is a rare disease, but anal cancer does exist and deserves our attention.

The cases of anal cancer are a lot more prevalent in gay and bisexual men or, “men who have sex with men” (MSM).  Unfortunately, most MSM’s have not been tested or know that any screenings are out there, and do not know much, if anything about anal cancer. Medical professionals are actually divided on whether they should even screen for it and how they would do so. Currently, there isn’t any standardized protocol for anal cancer screening.

Facts about anal cancer:

• Anal cancer is diagnosed in approximately two out of every 100,000 people in the general population every year.
• MSMs who are HIV negative are 20 times more likely to receive an anal cancer diagnosis (about 40 per 100,000 people)
• MSMs who are HIV positive are up to 40 times more likely to receive this diagnosis (about 80 per 100,000 people)
• The same strains of Human Papillomavirus (HPV) that cause cervical cancer in women also cause anal cancer
• In MSMs, HPV is transmitted through both protected and unprotected anal intercourse and skin-to-skin contact. HPV is very common– approximately 75 percent of all sexually active adults acquire HPV; not all HPV infections lead to cancer.

A number of men don’t have any apparent symptoms of HPV, but possible symptoms include:

• Genital warts affecting the anus, penis and/or peritoneum
• Abnormal discharge from the anus
• Bleeding from the anus and rectum
• Itching of the anus; pain or pressure around the anus
• A sore or sores that do not heal, around the anus

Since the cervix and anus are similar, biologically, and both are target areas for HPV infection, a pap smear can be used test the anus for pre-cancerous cell changes and cancer.  More and more health activists and gay physicians believe this procedure could reduce the incidence of anal cancer as significantly as it has with cervical cancer in women.

It is recommended by them that all MSMs, especially those who are HIV positive, receive testing every 1 to 3 years, depending on their CD4 count and immunology wellbeing.  Their recommendation for HIV negative MSMs is for testing every 3 years.  Other physicians don’t believe all MSMs need to be tested due to the small number of cases, facility shortages for follow-up procedures, and the cost, pain and fear of looking at small changes in cells (dysplasia). In addition, the number of insurance policies that would cover pap smears for the anus is low.

Even though the AIDS Institute of New York recommends that HIV positive gay men “and others with history of HPV disease” be tested annually, there appears to be little agreement about the importance and practicality of offering all MSM clients this testing.

Dr. M. Mirza, lgbt health wellness .com – 2015