Anal cancer is an uncommon, often curable cancer that produces slow-growing tumors and lesions in the anus and nearby anal anatomy. Most anal cancers are associated with human papillomavirus (HPV), which causes warts on the anus and genitals, similar to cervical and other cancers of the reproductive system. Providers recommend annual anal Pap smears to HIV-positive men who have sex with men (MSM), and biannual Pap smears to HIV-negative MSM. Pap smears screen for HPV and abnormal tissue growth (dysplasia). Routine anal Pap smears may reduce the incidence and progression of anal cancer, as they have for cervical and uterine cancer. The prognosis is good if the cancer is discovered early.
Incidence and Prevalence
Anal cancer affects men and women, but it is the only cancer with a greater prevalence among men who have sex with men (MSM) than in the general population. About 35 in every 100,000 MSM develop anal cancer, compared to less than one in every 100,000 heterosexual men. The risk for anal cancer in HIV-positive men is twice as high as that for HIV-negative MSM.
The American Cancer Society estimates that there will be 3,500 new cases of anal cancer among men and women in 2001 and 500 deaths resulting from it. Cancer of the perianal skin around the anus is more common in men, while tumors of the anal canal more often affect women.
Anal cancer accounts for only 4% of all cancers affecting the digestive tract.
Diagnosis
Anal cancer is diagnosed with an anal Pap smear, in which a cotton swab is inserted past the anus and swirled to capture a tissue sample. The tissue cells are examined under a microscope for signs of dysplasia. An abnormal Pap smear shows signs of excessive cell growth and is followed by a colposcopy, the internal examination of specific lesions or areas of cell growth for biopsy. Acetic acid (vinegar) is introduced into the anal canal to prepare the cells before an anoscope, a plastic tube, in inserted. The provider inserts a colposcope through the anoscope to visualize the cells in the anus with magnification. The procedure is painless. During a biopsy, a biopsy forceps is inserted in the suspect tissue to obtain a sample for close examination. Lesions and tumors found during a colposcopy are typically biopsied.
Anal cancer may be discovered during a routine digital rectal exam (DRE), in which a medical professional inserts a gloved finger past the anus to feel for abnormalities.
http://www.lgbthealthchannel.com/msmcancer/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 story
So 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 now show that the rates of anal cancer are much higher in gay men and men who have sex with men (MSM) with HIV.
* Eight of every 100,000 women will get cervical cancer. Compare this to the numbers for men who have sex with men: 35 of every 100,000 will develop anal cancer. The risk in the general population is 0.9 per 100,000.
* The risks to HIV infected people are even more staggering...in one study, 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. And, unlike some other diseases, anal cancer does not seem to improve with better HAART therapy.
* In one study, 28 men with anal cancer, low CD4 counts, and high viral loads, were given HAART therapy and saw good results HIV virologically. But, only 1 of the 28 experienced a regression of lesions or cancer. This indicates that HAART may have little impact on anal cancer.
* In a recent study in San Francisco, anal pap smears are abnormal in about 40% of HIV positive men.
The Procedure
The anal PAP screening is very simple, painless, and quick. Simply put, 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. In a few days, the physician will have the results and will discuss them with you.
But 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 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:
1. Imiquimod: This is a topical agent that has limited effect because it so easily gets rubbed off.
2. Therapeutic vaccines: These may work, but one needs to have a strong immune system for vaccines to work well.
3. Onxy-015: This is a recombinant adenovirus that is about to enter clinical trial phase. It has the ability to kill cells infected with HPV.
http://aids.about.com/cs/conditions/a/analpaps.htmHuman papilloma virus poses particular risks for MSM. In a 1998 study, 61% of HIV-negative men and 93% of HIV-positive men showed evidence of HPV infection.2'' As with cervical cancer, HPV infection has been strongly associated with anal cancer. Thus, although the risk of anal cancer in the general population of men is 7 per million, the risk is 35 per 100,000 in MSM (rivaling the rate of cervical cancer in women prior to the introduction of routine Pap smears).7 The rate of anal cancer in HIV-positive men is twice as high as in HIV-negative men.21 Although it has not become standard of care, experts now recommend anal Pap smears for high-risk men. Abnormal Pap smears would be evaluated by referral for anoscoopy. Data on outcomes are limited, but the sensitivity of anal Pap smears has approached 98%, although the specificity for predicting severe dysplastic changes is much lower.2 Surgical treatment of anal HSIL has shown excellent results in small numbers of HIV-negative men; unfortunately, HIV-positive men have had high rates of recurrence.6
http://findarticles.com/p/articles/mi_qa4100/is_200606/ai_n16501061Regulators in Australia and the European Union have approved the vaccine, called Gardasil and made by Merck, for boys ages 9 to 15. They cited data showing that it produced an immune response in boys, though its effectiveness in preventing infection in sexually active men has not been proved.
As with prescription drugs, doctors in the United States can provide the vaccine “off label” to anyone. “The approval is for marketing and distribution, but medical providers can use it in ways they feel is appropriate,” said Dr. Jeffrey Klausner, director of S.T.D. prevention at the San Francisco Department of Public Health.
Dr. Eliav Barr, a director of clinical research at Merck, said he had heard that some men were receiving the vaccine, but added that the company was barred from promoting it for men unless the F.D.A. approved it for that use.
That is unlikely to occur for at least a couple of years. Merck is sponsoring a clinical trial of Gardasil in 4,000 men, including 500 self-identified gay men. The first results are expected toward the end of next year.
http://www.nytimes.com/2007/01/30/health/30virus.html?ex=1171342800&en=164dc531bf34761a&ei=5070Anal Cancer Screening for Gay and Bisexual Men Would Save Lives and be Cost Effective
For immediate release: Tuesday, May 30, 2000
Boston, MA and San Francisco, CA--Just as use of Pap smears has led to a dramatic drop in cervical cancer, so screening for anal cancer among gay and bisexual men would save many lives at a reasonable cost, according to a study conducted at the Harvard School of Public Health and University of California at San Francisco. Anal squamous cell cancer and cervical cancer are similar diseases, both caused by a sexually-transmitted virus called human papillomavirus (HPV).
The study, led by Sue Goldie, MD, assistant professor at the Harvard School of Public Health's Harvard Center for Risk Analysis, predicts that the use of a simple and inexpensive procedure, comparable to a Pap smear, would lead to detection of pre-cancerous lesions among high-risk, HIV-negative men and allow for removal of these lesions and early treatment of anal cancer. A study by the same scientists last year reported similar findings for HIV-positive gay men.
http://www.hsph.harvard.edu/press/releases/press05302000.htmlHPV has similar carcinogenic effects on the anus as it does on the cervix. Anal cancer is preceded by detectable premalignant changes in the anal mucosa and is related to specific HPV infections. Similar to cervical Pap smears, checking for pre-malignant lesions of the cervix, it is recommended that anal cytological screening be performed every three years for all individuals (men and women) who engage in receptive anal intercourse, and every year for HIV positive individuals who engage in receptive anal intercourse<1> <4>.
http://www.genderandhealth.ca/en/modules/sexandsexuality/gss-gay-men-issues-04.jspnow i live in an area where 40% of gay men have been exposed to hpv -- can you figure out why my doctor would do an annual smear?
or why this vaccine is extremely important to both genders?
you can see that both australia and the european union are vaccinating boys -- i'm guessing the sheer weight of medical and public health care experts so far outweighs your position here -- as to make you look ridiculous.
but here's more --
here's just the very briefest overview of what vaccines have done for humanity -- so many millions saved as a result.
now that's not saying that people like don't want vaccines to be safe -- or that we don't big pharma cut off from the conduits of power --
but this vaccine is a very good thing.
http://blogs.cgdev.org/globalhealth/January 22, 2007
Hundreds of Thousands Saved: A Measles Success Story
The numbers are in! The Measles Initiative, which set out to halve the global measles burden between 1999 and 2005, has surpassed its goal with a 60 percent reduction. A new Lancet study (subscription required) reports an estimated drop in measles deaths from 873,000 in 1999 to 345,000 in 2005 (based on a natural history model to evaluate mortality trends).
For related coverage, see The Economist, the Washington Post, the New York Times and elsewhere. But also be sure to check out CGD's Millions Saved for a detailed account of how measles was nearly eliminated in seven southern African countries in the late 1990s. The case study suggests some key ingredients for the intervention's success: the commitment of governments, the strengthening of surveillance systems, and the integration of measles vaccinations with other health services. Some of these reasons are echoed by WHO director Margaret Chan in an International Herald Tribune op-ed on the more recent Measles Initiative success. She said that "it took a new partnership - with commitment, caring and cash - to turn things around," and noted that the success in countries was aided by their ability to build on the strategies and infrastructure of existing health programs and services.
As usual in public health, this success implies more work to be done. In a good sign that past successes are being used to inform future aims, the Measles Initiative has already set a new goal of reducing measles mortality 90 percent by 2010. Margaret Chan is optimistic that the new measles target will be achieved; so am I.
http://www.cgdev.org/section/initiatives/_active/vaccinedevelopment/overviewNowhere are the potential benefits greater than in the production and distribution of new vaccines to prevent the diseases that needlessly take lives and destroy livelihoods in developing countries.
In 2003 we established a Working Group, including economists, public health professionals, lawyers, experts in public policy and pharmaceutical and biotech experts, with the mandate to develop a practical approach to the vaccine challenge: to go from ideas to action. The result is this report.
My colleagues propose an elegant solution to enable the high income countries to work together to accelerate the development of vaccines for diseases of low-income countries to guarantee to pay for such vaccines if and when they are developed. The solution is simple and practical. It unleashes the same combination of market incentives and public investment that creates medicines for diseases that afflict us: arrangements that have been spectacularly effective in improving the health of the rich nations in the last century. It creates incentives for more private investment in these diseases. And it will ensure that, once a vaccine is developed, the funds will be there to get the vaccine to the people who need it.
Adequate investment in global public goods should be a cornerstone of foreign assistance. By definition, we all benefit from global public goods, and we share a responsibility to see that they are properly funded and available to everyone. These are investments with high returns and low risks of corruption and appropriation. Furthermore, this proposal ties funding directly to results: if the commitment does not succeed, there is no cost to the sponsors.
Every so often, an idea comes along that makes you ask: now why didn't I think of that? This is such an idea.
Nancy Birdsall
President
http://www.savekids.org/vaccines/v.htmlthe above site is comprehensive in recording both past achievements and current achievements for saving millions of lives through vaccinations.
truly a remarkable human achievement.
this describes an effort to save 5 MILLION CHILDREN through vaccination
http://www.dfid.gov.uk/news/files/pressreleases/iffi-bond.aspThe first step was taken today to raise funds for a mass immunisation programme for children in the developing world, at a ceremony in London attended by the Chancellor of the Exchequer Gordon Brown, Queen Rania Al-Abdullah of Jordan, and representatives of Britain’s faith groups.
The International Finance Facility for Immunisation (IFFIm) will deliver 4 billion dollars over the next ten years to be spent on the immunisation of up to 500 million children in the world’s 70 poorest countries against preventable diseases like polio, measles and diphtheria. It is estimated this will save 5 million lives in the years up to 2015, and a further 5 million afterwards, and lead to the eradication of polio.
Speaking in advance of the launch, the Chancellor said:
"Millions of people campaigned to Make Poverty History last year, and now we can say to them all: we are delivering the promises we made, your hopes are becoming a reality, and millions of young children's lives will be saved as a result."
IFFIm uses long-term, binding commitments from donors as collateral against which to borrow money up front from institutional and private investors, which can be spent immediately on mass vaccination programmes. Commitments have so far been made by the UK, France, Italy, Spain, Sweden, Brazil and South Africa, together with the Bill and Melinda Gates Foundation.
The first step was taken today to raise funds for a mass immunisation programme for children in the developing world, at a ceremony in London attended by the Chancellor of the Exchequer Gordon Brown, Queen Rania Al-Abdullah of Jordan, and representatives of Britain’s faith groups.
The International Finance Facility for Immunisation (IFFIm) will deliver 4 billion dollars over the next ten years to be spent on the immunisation of up to 500 million children in the world’s 70 poorest countries against preventable diseases like polio, measles and diphtheria. It is estimated this will save 5 million lives in the years up to 2015, and a further 5 million afterwards, and lead to the eradication of polio.
Speaking in advance of the launch, the Chancellor said:
"Millions of people campaigned to Make Poverty History last year, and now we can say to them all: we are delivering the promises we made, your hopes are becoming a reality, and millions of young children's lives will be saved as a result."
IFFIm uses long-term, binding commitments from donors as collateral against which to borrow money up front from institutional and private investors, which can be spent immediately on mass vaccination programmes. Commitments have so far been made by the UK, France, Italy, Spain, Sweden, Brazil and South Africa, together with the Bill and Melinda Gates Foundation.
''Vaccines have been one of the most important health gains in the past century. Infants and young children are particularly vulnerable to infectious diseases; that is why it is critical that they are protected through immunization. The benefits of vaccination far outweigh the risks. Children who are not immunized increase the chance that others will get the disease. Since this effort 50 years ago, we can now protect children from more than 12 vaccine-preventable diseases, and disease rates have been reduced by 99% in the United States. Immunizations are extremely safe thanks to advancements in medical research and ongoing review by doctors, researchers, and public health officials; yet without diligent efforts to maintain immunization programs here and strengthen them worldwide, the diseases seen 50 years ago remain a threat to our children.''
http://www.cdc.gov/nip/events/polio-vacc-50th/the above quote is from the cdc re: the fiftieth anniversary of the polio vaccine and takes in the scope of what vaccines have brought humanity -- millions have been saved -- and many millions more will be through hard work and determination.