David L. Yurdin, PA-C, AAHIVMS
HIV Services Clinical Director
Who hasn’t heard about Farrah Fawcett’s battle with anal cancer? The well-known actress was diagnosed in 2006. Her diagnosis heightened awareness of anal cancer. However, not enough has been done to expand comprehensive screening among the at-risk population. Rates of cervical cancer have dropped dramatically with the use of screening Pap smears. At the same time anal cancer has increased.
Anal cancer is more common among men who have sex with men (MSM) with HIV infection or not. Rates are as high as 70-144 per 100,000 populations. HIV infected women and heterosexual men are also at risk. Just like cervical cancer, human papilloma virus (HPV) infection is the culprit. HPV is a so-called oncogenic virus. In other words, with chronic infection, it changes the affected tissue cells into precancerous and then possibly cancerous cells over a period of years. Tumors may go undetected for years until they increase in size to cause symptoms. HPV can also cause benign anal warts. It is important to note that although receptive anal intercourse does increase the likelihood of anal HPV infection, it is not a prerequisite for anal HPV or dysplasia (precancerous).
What exactly is an anal Pap smear?
The rationale for screening for anal cancer and precancerous cells is based on the success of cervical Pap smears in reducing cervical cancer incidence and mortality. Whereas cervical Pap smears are obtained using a vaginal speculum, anal Pap smears are different. Instead of using a speculum, a Dacron swab is carefully inserted into the anal canal and rectum to sample anorectal cells. The procedure is painless but sometimes minimal discomfort or pressure sensation. It is recommended that screening will be performed on a regular basis, perhaps every one to three years. If any abnormalities are detected, a colorectal specialist will perform further testing.
Who should be tested?
Certainly men who have sex with men, HIV infected or not. In addition, women who have had abnormal cervical Pap smears should be tested periodically. And anyone with a history of anal condyloma should be screened with an anal Pap smear. As with any cancer or pre-cancer screening strategy, the goal is early detection and treatment to prevent progression to invasive cancer.
Anal Pap smears will be offered to all at-risk patients beginning in 2016. If you have questions, please discuss with me at your next office visit.