Some Urge Type of Pap Test to Find Cancer in Gay Men
February 21, 2003
Some doctors and researchers at major medical centers have started to recommend that gay men undergo regular anal Pap smears to screen for cell changes that could lead to anal cancer.Adapted from:
Although anal cancer is rare in the general population, the risk for men with a history of anal intercourse can be more than 30 times as great, published studies have shown. Researchers from the University of California-San Francisco, Stanford, and the Harvard School of Public Health have reported that gay men with HIV are at even more significant risk.
An anal Pap smear, which involves taking a swab of cell tissue from the rectum, is similar to the Pap tests that women receive to screen for precancerous cells in the cervix. Cervical and anal cancers can be fatal if they are not caught early enough. The cancers -- as well as cell abnormalities called dysplasia, which can progress to cancer -- are linked to infection with the human papillomavirus, or HPV.
"We've decided as a society that it's important to spend billions of dollars to test for and treat cervical dysplasia before it turns into cancer," said Dr. Joel Palefsky, a professor of medicine at UCSF. "And we should also be testing for and treating anal dysplasia in high-risk populations."
A number of studies have reported that sexually active gay men, especially those with HIV, are at high risk for anal infection with HPV. A 1998 study, co-authored by Palefsky, showed that 61 percent of 262 HIV-negative gay and bisexual men in San Francisco and 93 percent of 346 HIV-positive gay and bisexual men were infected with anal HPV. The full report, "Prevalence and Risk Factors for Human Papillomavirus Infection of the Anal Canal in Human Immunodeficiency Virus (HIV)-Positive and HIV-Negative Homosexual Men," was published in the Journal of Infectious Diseases (1998;177:361-367).
Treatment of anal dysplasia involves either burning off the abnormal cells or surgically removing them. Because the anal Pap smears and the treatment of anal dysplasia are still considered experimental, insurance companies generally decline to pay for them. But they do pay for treating anal cancer, which usually responds well to a combination of chemotherapy and radiation.
The problem is growing because many men with HIV are taking effective antiretroviral medications and are living long enough to develop anal cancer. Palefsky recommends anal Pap smears every two to three years for HIV-negative gay and bisexual men and annually for those who have HIV.
New York Times
02.18.03; David Tuller
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.