Anal cancer is around 50 times more common in gay men with HIV than it is in the general population. Should we be demanding screening and vaccinations? Gus Cairns investigates.
Fri, 29/07/2011 - 9:21pm
Everything okay down there? Screening for anal cancer
Published: 17 July 2011
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In May 2009, HTU wrote about cervical cancer in women with HIV (Cervical cancer and you, HTU 186).1 That article quoted recommendations for “aggressive” annual screening for cervical cell changes, because women with HIV were twice as likely to be infected with the human papillomavirus (HPV), the virus that causes the cancer, three to four times more likely to develop pre-cancerous abnormal cells, and twelve times more likely to get invasive cervical cancer if they do.2 If they do get cancer, there is a one in three chance they will be dead of it within ten years.3 But a simple procedure under local anaesthetic can remove pre-cancerous cells if they are identified – and the national screening programme has cut mortality by nearly two-thirds.4 And we now have a vaccine against the two most common cancer-causing varieties of HPV, with a programme to give that vaccine to all teenage girls.
Anal cancer is caused by the same virus and, in the same way as cervical cancer, causes pre-cancerous changes in cells that can be screened for and treated. It’s about 16 times rarer than cervical cancer in the general population. But it’s about 60% more common in women than men and about 50 times more common in gay men with HIV (because anal sex is a risk factor) – which makes it as common in them as cervical cancer is in HIV-positive women and is a huge risk increase: for comparison, lung cancer is ‘only’ 25 times more common in heavy smokers than in non-smokers.5 If you do develop anal cancer, there’s a one-in-three chance you’ll die of it within five years.6,7
But, unlike the regular check-ups for cervical cancer in women, there is no standard screening for anal cancer, or even any agreement about whether it would be a good thing. And although the HPV vaccine has been licensed for use in boys in the US, a licence for this use has not been granted in Europe.
Why not? Should we be agitating for better screening – especially of gay men with HIV – for anal cancer and for extending the HPV vaccine to boys?
Click here for the FULL article on aidsmap/NAM
HIV Treatment Update - HTU issue 208: July 2011 click here for the full monthy journal and how to subscribe.
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