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Anal Cancer: What You Should Know

March 21st is Anal Cancer Awareness Day – a cancer that is relatively rare in the general population but is unfortunately much more common in folks who live with HIV, and especially HIV+ men who have sex with men. Due to discrimination and stigma, there is a greater possibility that people at increased risk may neglect care. At Callen-Lorde, we are targeting our outreach efforts to screen all at-risk patients to detect anal cancer early while also working to improve the lives of our patients living with anal cancer.

Anal cancer is a disease that is almost exclusively caused by a virus called HPV (the Human Papillomavirus).  Most sexually active adults have at least one strain of HPV and for many people, it causes no significant health issues.  However, HPV has the potential to cause changes in the skin in a variety of vulnerable locations, including the anal canal.  These changes are not uncommon and are usually taken care of by a person’s immune system on their own.  In some people however, these changes can continue unchecked – leading to abnormal growth past the skin causing cancer – which happens at significantly higher rates for at-risk populations.

All folks living with HIV have a somewhat increased risk for the development of anal cancer, but it especially impacts those who were male assigned at birth and have a history of male sexual partners.  HIV+ folks with a history of abnormal changes in the cervix or vagina due to HPV are also at significantly increased risk for anal cancer.  Other risk factors include increasing age, smoking, and the number of lifetime partners for receptive anal sex (bottoming.)

Symptoms of anal cancer include bleeding from the anus or rectum, pain in the anus area, a mass or growth in the anal canal, and anal itching. If you are at risk of anal cancer or have experienced any of the listed symptoms, talk to your medical provider.  At a minimum, anyone with increased risk should have an annual anal exam that includes a digital rectal exam (an exam where the provider examines the anal canal with a gloved finger).

Fortunately, there are vaccines available to help prevent infection of the strains of HPV that may lead to anal cancer. It’s best to get the vaccine before you start having sex, but it can still be effective for those who are already sexually active (especially before the age of 26, but up until the age of 45.) The vaccine is effective enough that, like many other diseases, if enough people get this vaccine, HPV-related cancers could be largely be a thing of the past.

Colorectal cancer is also worth mentioning when discussing anal health. Also known as bowel cancer, colorectal cancer is when cancer develops in the colon or rectum, both parts of the large intestine. When detected early, colorectal cancer is one of the most preventable forms of cancer. Everyone over the age of 50 should be screened for colorectal cancer regardless of gender and the types of sex they are having. There is no evidence that suggests queer identities or HIV status impact your chance of contracting this type of cancer, however, smoking is a known risk factor. There are a number of colorectal screenings  ranging from colonoscopies to at home stool sample collection.

At Callen-Lorde, we have offered comprehensive anal cancer prevention care for more than a decade.  This includes annual anal cytology (“pap smears”) for folks at increased risk.  If that screening test is abnormal in any way, people are referred to our High Resolution Anoscopy program, started by Jeff Huyett – a Nurse Practitioner at Callen-Lorde – back in 2008.  High Resolution Anoscopy (HRA) is then used to detect and treat the skin changes caused by HPV that increase the lifetime risk for anal cancer developing.

Talk to your provider during your next medical visit about your risk for HPV related cancers, including anal cancer, and see if a vaccine or other prevention option may be right for you.