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Anal cancer in gay men
As with cervical cancer in women, Human Papilloma Virus (HPV), a wart virus, is thought to be responsible. If this is correct then anal cancer has become a newly recognised sexually transmitted disease.
HPV has very many different subtypes. The virus which causes the common genital warts is usually subtype 6 or 11. HPV responsible for the development of what are termed “anogenital” cancers are usually types 16, 18, 31 and 45, though subtype 16 is the most common of all of these. Consequently, human genital warts do not cause cancers, but one of their relatives which doesn’t cause the physical appearance of warts, might.
Both being a gay male and also HIV infection will separately increase the risk of anal cancers. HIV positive gay men will have an anal cancer rate of at least twice the “normal” population, so increasing it to around 70 per 100000. If you bear in mind that cancer of the cervix in women has a rate of around 8-10 per 100000 then you can see the extent of the problem. Other risk factors are high number of sexual partners and a past history of sexually transmitted diseases and finally the rectal use of recreational drugs “booty-bumping”.
Some researchers are now calling for all gay men, and particularly those who are HIV positive, to be screened in much the same way as we screen women for cervical cancers – by taking an anal “smear”. Again, in a recent study in San Francisco around 40% of men who had anal samples taken and were HIV positive, were found to have abnormal anal smears. Doctors are encouraged by the success of cervical screening programmes in different countries in reducing the cancer rates from around 40 per 100000 when the programmes began to the current 8-10/100000.
The problem with this approach is that anal smear testing is not a widespread activity amongst doctors and is rare in the USA but even rarer in the UK. Doctors don’t often know how to take the samples. Laboratories are not geared up to analyse them. Even if they were, treatment options and strategies have not yet been developed. All the current thought about screening is speculative. The biggest barrier though will be doctors who don’t see the need and patients who don’t understand the need.
It is likely, I think, that anal smear testing will become more common and more directed to the gay male population particularly those who are HIV positive. There are very definite advantages to early detection, because treatment with radiotherapy or chemotherapy or both gives impressively good results and leaves a normal anus. The old fashioned surgical treatments of the past are rare these days.
Whilst we wait for a national screening programme, we can improve things by watching out for the important symptoms. These are mainly rectal bleeding, rectal pain or the feeling of “something there” in the anus and finally the appearance of swollen glands in the groin. If you do experience or develop any of these symptoms then it is very important to see your doctor early rather than late. When you do see him or her, you should have a thorough inspection of the anal canal and the groin, probably with collection of samples by swab.
It is vital also to get other infections diagnosed and treated, because of the independent association anal cancer has with other sexually transmitted infections or STD testing clinics. Some infections, like anal syphilis and also some special types of anal Chlamydia, might mimic cancers and vice versa. The infections are usually treatable with anti-biotics but they must be accurately diagnosed first.
Try not to fall into the trap of thinking that everything that goes wrong with your bottom is piles. Hopefully it will be but get it checked out first.
