Anal and Cervical Cancer Screening - Round Table Discussion

Australasian Society for HIV Medicine: Emerging recognition of anal cancer as a public health issue for gay men

Prof Joel Palefsky followed up his overview given at the ASHM conference the day before with practical tips on how screening and treatment for this condition can be set up. The condition and its management are remarkably similar to cervical cancer. This includes the use anal pap smears (known as a "toosh pap" on the West Coast of the US, or a "chap smear"in Sydney!), colposcopy, liquid nitrogen and surgical treatments. However one major difference is that many men he sees have abnormalities he can do nothing about. One more recent treatment being trialed is an antioxidant from broccoli.

The epidemiological aspects were reviewed by Dr Andrew Grulich from the National Centre for HIV Epidemiology and Clinical Research. Support for a screening program exists in the evidence, but there is little evidence that screening would improve the outcomes of treatment, that the program would be cost-effective or that it would be acceptable to the community. Dr Sue Garland from the Melbourne Royal Women's Hospital gave a review of cervical cancer and Human Papilloma Virus (HPV) infection. Recent evidence confirms that HIV positive women have a higher prevalence of HPV; the infection is more likely to persist, have higher HPV viral loads, be due to multiple genotypes of the virus and a higher relapse rate of cell abnormalities following treatment. She also pointed to evidence that HIV positive women have higher rates of anal cancer.

Prof Palefsky also described higher rates of anal cancer in HIV positive men who have never had receptive anal intercourse. This may in part be due to transmission of HPV with sex toys, fingers etc, but is also seen in HIV positive IDUs who have never had male to male sex. Dr Grulich advocated the introduction of anal cancer-screening program together with further research. Prof Palefsky strongly advised against doing anal paps before the infrastructure and expertise to deal with any abnormalities is in place.