It is a little over a year since the Positive Life NSW President Malcolm Leech died of anal cancer and I've been thinking of him and his commitment to the myriad of health and social issues faced by peoples' living with HIV. I've come to realise that we need to avert other deaths from anal cancer in gay men and people with HIV.
Positive Life, along with ACON, has been community partners in SPANC (Study of the Prevention of Anal Cancer). This study is currently running in Sydney and has about 12 months to go. It's one of the largest studies of human papilloma virus (HPV) in gay men.
The study follows gay men at five visits over three years and examines the course of HPV disease, which is believed to be the precursor to anal cancer. Anal cancer and cervical cancer in women are caused almost entirely by infection with HPV, a family of more than 100 different viruses that cause everything from common warts to genital warts and cancers.
Most sexually active people will acquire at least one type of HPV and just about all HIV positive gay men have detectable HPV infection.
The high-risk HPV type associated most often with anal cancer is HPV16, followed by HPV18. Persistent infection (or reinfection) with high-risk HPV types is an important factor in developing anal cancer. HIV positive gay men have 80-100 times the risk and gay men have about 30 times the risk of anal cancer compared to the general population; and HIV positive women have approximately 15 times the risk of anal cancer compared with the general female population.
People with lowered immunity and people who smoke are at greater risk of anal cancer and the risk increases with age.
One important factor to note is that in many cases, the body will eventually get rid of HPV infection. The average length of any single anal HPV infection is about five months to a year for HIV negative people. However HIV positive people and people with weaker immune systems may take longer to get rid of HPV infection. You can also be reinfected with HPV.
The good news is that if anal cancer is diagnosed very early, survival rates are good, but if picked up late, prognosis is poor. There are currently no accepted guidelines for anal cancer screening.
This is because there are a number of major concerns about the accuracy of screening tests, the side effects of treatment, and effectiveness or not, of treating pre-cancerous lesions. The SPANC study hopes to increase our understanding of these issues. So until the findings from this research become available, the following approaches can be taken to either decrease your chance of developing anal cancer or detecting anal cancer when it is small and has a better prognosis:
1. Stop smoking
2. Get an annual digital anal examination from your GP
3. Get checked for any anal symptoms like a lump; bleeding, sores, or pain
If you haven't already turned off and stopped reading, you may be thinking this information is yet another bad news story, in a long line of bad news stories. This may be particularly so if you're a gay HIV positive man over fifty whose been lived with HIV for some time, and smokes.
We've been through a lot, the bad days of AIDS, the evolution of modern treatments and those intolerable side effects, increased rates of inflammatory and age related diseases, and scary predictions about neurological impairment – to name a few. It's no wonder some of us have succumbed to HIV related fatigue, depression and apathy.
Added to this is the fact that gay men have a special relationship with their bottoms. We are not like straight men, which by preference have an entirely different attitude and relationship to their bums. For us it's a two way passage, an entry as well as an exit.
So, if you haven't been examined 'down there' for some time – other than during a hot play session – please go to your doctor and ask him to perform a digital anal examination. Get checked out!
Detecting an abnormality, particularly if you're at high risk of anal cancer, can save your bum and your life.