Is anal cancer on your radar?

Whilst anal cancer is rare in the general population, rates are rising globally due to changes in sexual behaviours. It is significantly more common in people living with HIV, men who have sex with men, immunocompromised people and trans and gender diverse people. When compared to the general population, men who have sex with men and are living with HIV have 50-100 times higher risk of developing anal cancer.

The main risk factor for anal cancer is exposure to the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection. HPV can cause cancerous lesions and warts. The most common sites affected are the cervix, anus, vagina, penis and throat. Additional risk factors for anal cancer include receptive anal intercourse before the age of 30, higher lifetime number of sexual partners, current cigarette smoking, genital warts, immunosuppression and advancing age.

The strong link between HPV and anal cancer mean that anal cancer is potentially preventable by early HPV vaccination. HPV vaccination is part of the National Immunisation Schedule and is also recommended for 9-45 year old people who are immunosuppressed, including people living with HIV and for men who have sex with men. Whilst vaccination is most effective when given before becoming sexually active, in many cases the benefits may still be worthwhile.

Digital ano-rectal examination (DARE) and peri-anal examination aims to detect early anal cancers. Men who have sex with men, are living with HIV and are over the age of 50 years are recommended to have this annually. People from other high risk groups should discuss this with their clinician. The DARE is about checking for irregular lumps in the anus. It involves the painless examination by the clinician’s gloved finger of the anus and can be conducted during your routine HIV check-up or at a consultation at any of the Clinics of the Statewide Sexual Health Service The benefit of early detection of anal cancer is that treatment options are less aggressive and have better survival outcomes.

Anal pap smears +/- high resolution anoscopy aim to detect pre-cancerous precursor lesions. There are currently Australian studies looking into whether men living with HIV should have anal pap smears, in the same way that women have cervical pap smears. Regularly monitor for symptoms and signs of anal cancer and have an annual check up. Symptoms include rectal bleeding, anal or perineal pain, a lump in or extending from the anus, itchy anus, faecal incontinence, anal fistula, anal discharge and ulceration.

If you are a man over 50 years who has sex with men and is living with HIV, we recommend that you have an annual DARE and peri-anal examination.