What is an Anal Pap?The anal pap is a test similar to the pap test in women. A sample of cells is collected from the anus and rectum. They are then examined under the microscope to identify any structural changes in the cells. These changes are precursors to anal cancer, a type of cancer on the rise in gay and bisexual men.
The Link Between Anal and Cervical CancerAnal cancer in men and cervical cancer in women are both thought to be linked to the Human Papillomavirus (HPV). HPV, the same virus that causes genital warts is common, especially in bisexual and gay men. Women also have a high incidence of HPV, passed to them through unprotected vaginal intercourse with HPV infected men. The belief is that it is this prevalence that has caused the rise in anal cancers. Gay and bisexual men with HIV are especially at risk because they are at higher risk for persistent HPV infection. And unlike other sexually transmitted diseases, condoms are not effective in preventing HPV infection.
The Numbers Tell the StorySo what is the prevalence of HPV and anal carcinomas (cancers) in men? Is anal papilloma screening worth the cost of the test? The numbers tell the story.
Studies show that the rates of anal cancer are much higher in men who have sex with men (MSM) and are HIV positive.
- Disproportionate Rates of Anal Cancer
- eight of every 100,000 women will get cervical cancer
- 35 of every 100,000 msm will develop anal cancer
- the risk in the general population is 0.9 per 100,000
- Staggering Rates Among the HIV+
- HIV infected people are twice as likely to contract anal cancers as are HIV negative people.
- As a person progresses toward an AIDS diagnosis, the risk increases further.
- Anal cancer does not seem to improve with better HIV medication regimens.
- HIV Medication Not Much Help
In one study, 28 men with anal cancer, low CD4 counts, and high viral loads, were given an HIV medication regimen and saw good results in controlling HIV. But, only 1 of the 28 experienced a regression of anal lesions or anal cancer. This indicates that HIV medication regimens may have little impact on anal cancer.
- High Incidence of Abnormal Anal Paps
In a recent study in San Francisco, anal pap smears were abnormal in about 40 percent of HIV positive men.
The Anal Pap ProcedureThe anal PAP screening is very simple, painless, and quick. The physician uses a Dacron swab and collects cell samples from the anal canal by swabbing all surfaces of the anus and rectum. These cell samples are sent to a lab where technicians prep the samples and look at them under a microscope to identify any cellular changes that may indicate cancer. In a few days, the physician will have the results and will discuss them with you.
Preparing For Your Anal PapOne day (24 hours) before your anal Pap smear:
- Do not have anal receptive intercourse (sex)
- Do not put any creams, lubricants, or medications into your anus
- Do not insert sex toys or other objects into your anus
- Do not douche or take enemas
How Often Do You Need an Anal Pap?How often do you need an anal PAP? Sue Goldie, MD, MPH, the author of a anal PAP study at the Harvard School of Public Health found that screening gay and bisexual men every three years would identify many cases of anal cancer early -- when they can be treated successfully.
What is the Result is Abnormal?What if the test finds an abnormality? Initially, the cells in the anal canal develop abnormal, pre-malignant changes called intraepithelial (the superficial layer of the anal canal) neoplasms. These changes gradually worsen and become an invasive cancer. If abnormal changes are noted, further investigation and possible surgical excision by a laser may be necessary. Or, there are currently three methods of non-surgical treatment:
This is a topical agent that has limited effect because it so easily gets rubbed off.
- Therapeutic Vaccines
These may work, but one needs to have a strong immune system for vaccines to work well.
This is a recombinant adenovirus that is about to enter clinical trial phase. It has the ability to kill cells infected with HPV. Sometime in the future it may be a treatment option.
Needless to say, it is obvious that regular anal PAP screenings are an important part of staying healthy while living with HIV. While this test is gaining popularity, it may not be available in all areas. Consult your physician and tell him you want this screening. If he is unable to provide the screening, ask him to refer you to someone who performs the procedure. It could very well save your life.
UCSD Owen; "Anal Pap Patient Education Brochure"; UCSD 2004.