California: Doctors Want Pap Test for Gay Men

Anal cancer rates have increased 37 percent in the United States since a decade ago, when cases were increasing by 1 percent. Like cervical cancers, anal cancers are caused by human papillomavirus. Anal Pap smears would help doctors spot the disease before it grew malignant, say supporters who advocate widespread exams for gay men.

Nationwide, doctors have not embraced anal Pap screening, partly because there is debate about its efficacy and necessity. In the Bay Area, however, physicians are leading a drive for anal Pap exams in order to cut the rate of anal cancers.

"We haven't proven it yet, but we believe that we are likely to be preventing anal cancer," said Dr. Joel Palefsky, director of the Anal Neoplasia Clinic at the University of California-San Francisco (UCSF). This summer, Palefsky hopes to publish research making that case.

Anal cancer rates are low in the general population but are considerably higher among gay men, people with HIV and other immunocompromised persons. Bay Area doctors say the higher number of cases could be due to better reporting or may be associated with HIV rates. Nationally, there were 4,660 cases of anal cancer and 660 deaths last year, according to the American Cancer Society.

Until more definitive results are available, doctors need to decide whether they want to perform a visual exam or Pap test, said Dr. Michael Horberg, HIV/AIDS director for Kaiser Permanente and HIV specialist for Kaiser Santa Clara Medical Center.

The waiting time for appointments to remove anal lesions is four months at the UCSF clinic specializing in the outpatient procedure, which can take up to two weeks for recovery. Outside the Bay Area, though, many doctors wait for anal cancer to develop before treating it with chemotherapy and radiation.

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