by Paul Mittelstadt, MD
Anal cancer in gay men or men having sex with men (MSM) has the appearance of being the next major health crisis within the gay community. This disease has been discussed for years within the medical community of the USA but up to this point has received very little press in either the queer or popular press.
The scientific studies show that Human Papilloma Virus (HPV) causes both anal cancer and cervical cancer. The reason for this is that the anus and the cervix are composed of similar tissues. It has been known for decades that the predominate cause of cervical cancer is HPV. The cause of anal cancer, which is primarily also HPV, has only recently been discovered in approximately the last decade. Approximately 20 years ago, the incidence of anal cancer in both men and women was extremely low. Within the last 5 years, the incidence of anal cancer within the gay male community and MSM has risen by as much as an astounding 1800% depending on the study. The major risk factors appear to be the recipient in unprotected anal intercourse, cigarette smoking, and positive HIV status. In the past, it was thought the cause for anal cancer was hemorrhoids or anal tears. Due to this major increase in anal cancer within the gay population, the cause for anal cancer is now found to be HPV.
Testing is simply the male equivalent of the female Pap smear—simply a soft brush sample of the anus. If this test is positive, then further testing and/or treatment would consist of simply a weak acid treatment for localized early cancers to more invasive treatments such as medical freezing, stronger acid treatment, or surgical removal in advanced cases. Testing by screening is recommended every year for HIV positive patients or every 3 years for HIV negative patients. Screening at this point is routinely not done due to many reasons including low number of physicians trained to due anal cancer screening, reluctance of physicians to discuss anal screening with their patients, and fear from patients of discomfort or embarrassment with anal screening. Despite screening appearing to be cost effective for diagnosing and treatment of anal cancer, it should be noted that there has been a reluctance on the part of health insurance companies to pay for anal screening for what appears to be financial reasons.
Because the cause of cervical cancer and anal cancer—HPV—is the same, prevention of anal cancer appears to be the same as for cervical cancer. This is a 3-part vaccination series for HPV which has shown as much as an 80% decrease rate of anal cancer in fully vaccinated men. As a side note, unfortunately for HIV positive men, medication treatment for HIV does not prevent anal cancer nor does vaccination prevent anal cancer.
Testing for anal cancer is currently being done at a small limited number of medical facilities in the USA. It is hoped by this author that testing for anal cancer for MSM and gay men will become as routine as regular scheduled annual cervical exams for women.
This article is based on two medical articles published in March and April 2012.