Anal Cancer, HIV and HPV: Know Your Risk
Anal cancer has historically been considered a rare disease but its incidence has been increasing rapidly in recent years due to HIV. While AIDS deaths have decreased, the risk of anal cancer has increased in HIV+ individuals. HIV+ men who have sex with men comprise the highest risk group for anal cancer, where it is estimated that 1 out of 10 will develop anal cancer in their lifetime. This is higher than the risk of other common cancers in the population for which we screen, such as prostate or colon cancer. HIV+ women are also at increased risk of anal cancer. Other factors that increase one’s risk of anal cancer is a history of anal warts or, in women, a history of cervical, vaginal, or vulvar cancer.
Anal cancer is caused by the HPV virus, which also causes cervical cancer. The HPV virus causes precancerous changes to the cells of the anus or genital tract, which can then develop into cancer. These precancerous changes generally do not cause any symptoms, so the only way to know you have them is by screening with PAP smears. The incidence of cervical cancer has dropped 78% since PAP smears were introduced in the 1940s, allowing treatment to destroy these abnormal cells, preventing them from developing into cancer. It is felt that evaluation with anal PAP smears will likewise lead to diagnosis and treatment of abnormal anal cells, eventually leading to a decrease in the rate of anal cancer.
If an anal PAP smear is abnormal, the next step is high resolution anoscopy, where the cells of the anus are examined with a microscope and any abnormal cells can be biopsied. If the biopsies confirm precancerous changes, the cells can be treated with a variety of means to destroy them. Anyone who has had precancerous changes will need lifelong follow-up since these changes can recur, since the HPV virus itself cannot be cured.
In the future, the Gardisil vaccine may prevent many cases of anal cancer, as it has been shown to prevent the precancerous changes due to HPV from occurring.
Bayhealth is committed to offering preventive services for anal cancer. Bayhealth Colorectal Surgeon Elsa Goldstein, MD, is the only physician in the southern region to offer patients a program to try to prevent anal cancer using a combination of anal PAP smears followed by high-resolution anoscopy for abnormal Pap smears.
To schedule an appointment at either the Milford or Lewes locations, call Dr. Elsa Goldstein at Bayhealth Colon and Rectal Surgery, 302-503-2700.