Anal Cancer
Gay and bisexual men, especially those with
HIV, are at significantly higher risk for anal cancer than the
general population.
Statistics show that the rate for anal cancer
in gay and bisexual men (without HIV) is about the same as the
rates of cervical cancer in women before pap smears became
routine. Routine pap smears have decreased the incidence of
cervical cancer from 30-40 per 100,000 women to approximately
8 per 100,000.
The incidence of anal cancer among gay and
bisexual men who are long-term HIV survivors has increased
greatly. This is probably due in part to the fact that men are
now surviving longer with recent effective treatments.
Anal cancer and cervical cancer
are caused by the same viruses — "high risk" varieties of the
human papillomavirus (HPV). There are many different strains
of HPV, most of which cause harmless warts in various places on
the body (e.g., feet, hands, genitals).
A few high-risk
strains of HPV can lead to anal cancer or cervical cancer if
not caught and treated early. However, often infection
(even with those "high-risk" strains of HPV) doesn't result in
cancer.
Men become infected with anal HPV through
receptive anal intercourse. One study estimates that
approximately 95 percent of gay men with HIV and 65 percent of
gay men without HIV have HPV in their anal canals or the
surrounding skin.
Recommendations for gay and bisexual men
Recommendations for routine testing of gay and
bisexual men are as yet uncertain, as this is an area of
ongoing and active research, and no standards have yet been
adopted.
What is an anal pap test and how are lesions
and warts treated?
Warts are mostly caused by "low-risk" strains
of HPV that do not lead to cancer; however, they often need to
be treated. Treatment usually consists of freezing them with
liquid nitrogen or the use of surgery or cautery. Anal cancer
is caused by "high-risk" strains of HPV that can only be
detected with an anal pap test.
In this procedure, a health
care provider passes a swab into the rectum and collects
cells. These cells are then put on a slide that is examined by
an experienced pathologist in a lab under a microscope. It
takes many years for pre-cancerous anal lesions to develop
into cancer.
If the cells show changes of the kind that could
lead to cancer, the patient should undergo a thorough rectal
exam by an experienced proctologist. If the problem is caught
early before a cancer develops, it can easily be treated in a
doctor's office. Treatment for these anal lesions varies from
simple in-office procedures, such as freezing the cells or
applying a topical cream, to surgery or biopsy, if the lesions
are widespread.
Treatment is very effective in removing
lesions, but they may come back in the same or other areas, so
it is important to continue to have regular screenings.
Persons with advanced tumors will often need other forms of treatment.
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