Anal Pap Smears Important for MSM to Detect Anal Cancer

Men who have sex with men should have regular anal Pap smears as an important preventive step for anal cancer, as anal sex is a primary risk factor for anal human papillomavirus infection, a virus that can cause warts and lead to some forms of cancer, Salon.com reports. Salon.com interviewed Dr. Stephen Goldstone, a surgeon at Mount Sinai Medical Center in New York who specializes in rectal and anal disorders, who called anal cancer "an emerging health concern for gay men" and said the screening test is gaining acceptance but that even most gay physicians still do not recommend it to patients. According to Goldstone, anal HPV is common among MSM, particularly those with HIV/AIDS. Dr. Joel Palefsky, a research scientist at the University of California-San Francisco, has estimated that about 65% of HIV-negative gay men and nearly 100% of HIV-positive men carry HPV in their anal canals; many HIV-positive men carry the viral types that are more likely to cause pre-cancerous cell changes. Goldstone said that the incidence of anal cancer is 35 per 100,000 in HIV-negative men and 70 per 100,000 in HIV-positive men, figures that "are actually very significant because this is a disease we never really used to see. ... It's becoming more widespread." Although every MSM is at risk for HPV, transmission does not require penetration, as the virus can spread from skin-to-skin contact and condoms may not be protective. In addition, heterosexual men and women may contract anal HPV and should be routinely screened. An anal Pap smear involves the insertion of a non-lubricated swab inside the anus where it draws a cellular sample and a high-resolution anoscopy that looks inside the rectum for abnormalities. Goldstone recommends primary care physicians perform anal Pap smears on HIV-positive MSM every year and on HIV-negative MSM every two to three years, starting in their 20s. Goldstone noted a reluctance, even among gay physicians with gay patients, to deal with anal-rectal disease, because men "get tremendous embarrassment from the diagnosis," but said that patients "should be asking for this because they have tremendous power within the medical community" (Tuller, Salon.com., 9/10).