Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
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San Francisco Examiner - Tuesday, May 18, 1999
Ulysses Torassa, Examiner Medical Writer
Like cervical cancer, anal cancer is linked to human papillomavirus, a sexually transmitted disease that can prompt pre-cancerous lesions to form on the surface of the anus and cervix.
Although the research, to be published Wednesday in the Journal of the American Medical Association' focused on those with HIV, a similar trend has also been noted among HIV-negative gay men, said Sue J. Goldie, assistant professor of health policy at the Harvard School of Public Health.
Estimates are that 35 HIV-negative gay men per 100,000 will get anal cancer, and the rate is about twice as high among gay men who are HIV-positive.
By comparison, the rate of anal cancer in the general population is 0.8 per 100,000. The disease is hard to detect because there are few symptoms, and about 44 percent of those who contract it will die within five years.
Before Pap smears became widespread in the 1960s, the rate of cervical cancer was about 40 per 100,000 women. It is now down to eight per 100,000.
At a cost of about $25, a Pap smear can detect both cancer and the abnormal cell changes in the anus that are likely to lead to the disease.
Goldie and her colleagues aren't ready to recommend routine screening just yet, saying their information should be confirmed by data from other areas of the country. Also, more people need to be trained in both the test and in follow-up treatment.
Joel Palefsky, professor of laboratory medicine at UCSF and co-author of the study, runs one of the few programs to treat anal lesions. If they are small, he can burn them off with acid. Larger ones require surgery.
The effectiveness of the treatments hasn't been formally studied, but of the hundreds of patients treated by Palefsky, none has had cancer recur. However, he said many of them have been followed for only a short time.
Palefsky said he expects Pap smears to eventually become a regular part of medical care for men who have anal sex. And their favorable cost-to-benefit ratio will only help advance their acceptance faster.
"People in this health care environment always want to know what the economic implications are," he said. "Suddenly, people are taking a lot of notice."
The recommendation could also someday be extended to women who engage in anal sex, although Palefsky said data collection on that population is in its early stages.
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