Can I be screened for anal cancer? Can I prevent anal cancer?
Yes! There are ways to screen for “pre-cancerous” cells in the anal canal. The current gold-standard for screening is a simple anal swab. This has sometime been (erroneously) referred to as an “anal pap smear”. In this quick and painless test, a small cotton-tipped swab is inserted into the anal canal (by a provider or patients themselves). The swab is gently rubbed and twirled around the anus and then sent to a pathologist. The pathologist then looks for abnormal cells and can perform tests to look for cancer-causing strains of the human papillomavirus (HPV). A screening test is considered positive if there are abnormal cells or high risk HPV types found. Although there are over 150 types of HPV, only several of them are considered high-risk for anal cancer.
What happens if my screening test is positive?
If your screening test is positive, you should undergo a procedure called High Resolution Anoscopy or “HRA”. This procedure can be performed in about thirty minutes in a clinic or procedure room by a highly trained expert provider. This procedure can both identify and treat pre-cancerous lesions in the anus, termed “high-grade dysplasia”. A recent large clinical trial published in the New England Journal of Medicine has shown that HRA is effective at identifying and treating anal pre-cancers and was highly effective at preventing progression to anal cancer. You can learn more about HRA here.
Why haven’t I heard about this before?
Unfortunately, most people at risk for anal cancer are not screened. In a recent study we performed of over 3,000 gay men and transgender women living in the US, only 17% reported every having undergone an anal swab for cancer screening. Among those who had not undergone screening, less than 3% reported ever being counseled about anal cancer screening by a medical professional. This data matches other similar studies examining in gay men and transgender women. Very little is known about screening rates in other high risk populations including women living with HIV, women with prior gynecologic (cervical, vaginal, or vulvar) HPV-related disease, or Solid Organ Transplant patients. It is presumed that these populations have even lower rates of screening.
Reasons for low screening rates are multifactorial. Although there has been data linking men and transgender women who have sex with men, especially those living with HIV, to increased rates of anal cancer since the 1990’s, evidence showing the benefits of screening and treatment has only begun to emerge. Similarly, our understanding of other high-risk populations continues to unfold. Guidelines recommending routine screening with anal swab and treatment with HRA are relatively new. Many providers remain unaware of these guidelines. Click here to see if you are a member of a high-risk population and the current recommended age to begin screening.
SAVETHEBOTTOMS!!! aims to increase awareness of anal cancer risk AND screening/treatment options among patients AND the providers who care for them. Similarly, we aim to end stigma surrounding anal health and break down barriers to discussing sexual orientation, sexual practices, and anal health within healthcare settings and within the communities we seek to serve.