Anal Cancer Screening Needed
This editorial highlights the ongoing need for protocols for regular anal cancer screening for gay and bi men.
Anal Cancer Screening Would Save Lives
by Jen Hecht and Jason Riggs
More and more gay and bisexual men are battling anal cancer, caused by a virus that a majority of us have and most of us have never heard about. The virus is HPV (human papillomavirus), the most common STD in the world. HPV is transmitted via skin-to-skin sexual contact, so you can get it even if you use condoms every time. We now know that HPV is responsible for most cases of cervical cancer and alarmingly high rates of anal cancer among gay and bi men. Fortunately, anal cancer is highly preventable and treatable, if caught in time.
Rates of anal cancer among gay and bi men are similar to epidemic rates of cervical cancer in women 40 years ago, prior to the adoption of a routine screening that is now a standard in women's healthcare. The good news: the same screening may be effective for early detection of anal cancer. It's called a Pap smear, and it's not just for women anymore. Even better: a Pap smear is painless, inexpensive, and quick. Specialists are recommending that HIV-negative gay and bi men get a Pap smear every two years and positive men get an annual Pap smear. There are several techniques available to remove precancerous tissue in the doctor's office.
Currently, HIV-negative gay and bi men develop HPV-related anal cancer at a rate 35 times greater than the general population, according to studies published in the New England Journal of Medicine . Those of us who are HIV-positive are estimated to be a staggering 80 times more likely to get it, according a study published in the medical journal, Lancet. Rates of anal cancer among men have increased 160 percent over a 30-year period and continue to increase. In addition, black gay men are seeing the sharpest increase, with lower survival rates than gay men in general.
An article published by College of American Pathologists shows that 65 percent of HIV-negative men and 95 percent of positive men had HPV in their anal canal. Fifty percent of HIV-positive men with HPV in their anal canal had precursors for anal cancer. Most HPV infections are naturally cleared by the body and don't cause cancers, but some do.
Despite our risk for anal cancer and how easy it is to screen for, Pap smears are not part of our routine care. This neglect results in a highly preventable cancer advancing to malignancy among too many of us.
Unfortunately, there is a lack of education and research on anal cancer screening and treatments. As a result, it is unknown how effective Pap smears are for detecting pre-cancerous cells in the anus and no guidelines exist for an appropriate standard of care.
Some officials say they can't recommend anal Pap smears until studies are published and standards of care are developed. However, this was not the approach taken to prevent cervical cancer. It was considered poor practice not to enlist all the methods available at the time to do everything possible to prevent cervical cancer. Screening for cervical cancer moved forward despite a lack of definitive direction and regular screening has led to an 80 percent reduction in cervical cancer. Just as it is unethical to withhold treatment, it is unethical to withhold prevention.
Stop AIDS Project has taken up this critical issue with a series of awareness and advocacy initiatives. The first such effort is a community forum on Monday, April 9 from 7 to 9 p.m. entitled, "Hole Health." The event will take place at 2128 15 Street between Noe and Sanchez streets. Nationally recognized experts will present information and field questions. Panelists include Dr. Joel Palefsky, Dr. Rick Loftus, and Stop AIDS Project's Michael Scarce.
Recent medical advancements beyond Pap screening hold new promise. A new vaccine against several types of HPV is available for women and girls. Studies are under way to determine its efficacy with males. Some doctors are already prescribing it "off-label" to men who request it, even though it remains unclear how beneficial it can be for males, especially those who may already be infected. Physicians, advocates, and researchers who are advancing treatment and knowledge about anal cancer should be commended for their work.
Gay and bi men have a history of being our own health advocates. Here are a few things you can do to advocate for yourself: both tops and bottoms should talk with their doctor about anal cancer, HPV, and the new vaccine; get a Pap smear and/or a digital rectal exam; stop smoking (smoking is related to HPV's progression to cancer); and use condoms (reduces risk for HPV transmission).
HPV is common. A simple screening and some preventive care and treatment can help you be one less gay or bi man battling anal cancer.
For more information on anal cancer visit www.stopaids.org or http://www.analcancerinfo.ucsf.edu/.
Jen Hecht is the Education Director, and Jason Riggs is the Deputy Director of STOP AIDS Project.