Why are we not routinely screening for anal cancer?

By Dr Jodie Abramovitch

HIV positive men who have sex with men are at higher risk of developing anal cancer – a significant health issue. To date, little is known about the professional views of HIV clinicians on anal cancer screening.

Professor Christopher Fairley

To address this, a detailed survey of 20 HIV physicians was conducted by Dr Jason Ong, a PhD student of Professor Christopher Fairley who is based at the Melbourne Sexual Health Centre, and collaborators from the Central Clinical School, Melbourne University and the Kirby Institute (NSW).

Their research revealed that anal cancer screening within HIV positive men who have sex with men was considered a priority by clinicians. However, it was noted that there is currently no validated method for the effective screening of anal cancer - there is no evidence that detection of precursor lesions reduces mortality.

Another screening method proposed by HIV clinicians was an annual examination for precursor lesions by a doctor. Limitations of this approach include lack of awareness concerning the disease by patients and perceived discomfort associated with examination, varied HIV care practices between clinics (no routine practice to screen for anal cancer), and lack of opportunity during appointments to conduct an examination.

Encouragement of self-examination was also proposed. Evidence from other cancer types where self-examination is encouraged, such as testicular cancer, suggests there is low adherence to regular checks by patients at home.

This study concluded that there is a pressing need for more research to assess how best to effectively screen for anal cancer.

Reference: Ong JJ, Temple-Smith M, Chen M, Walker S, Grulich A, Hoy J, Fairley CK. Why are we not screening for anal cancer routinely - HIV physicians' perspectives on anal cancer and its screening in HIV-positive men who have sex with men: a qualitative study. BMC Public Health. 2015 Jan; 15:67

doi: 10.1186/s12889-015-1430-1