Your “anal health” probably doesn’t come up in most routine doctor visits, but many people are at an increased risk for anal cancer, specifically those who have HIV, men who have sex with men, and women who have had precancerous changes found on routine pap screening.
Over the past three decades, the incidence of anal cancer in the U.S. has doubled, and there are about 7,000 cases of anal cancer in the U.S. every year. Unlike colon and rectal cancer, most anal cancer is caused by a handful of strains of the Human Papilloma Virus, or HPV, that has hundreds of different subtypes and also causes cervical cancer in women. The most common symptom of colon cancer is anal or rectal bleeding. Most cases of colon cancer come from polyps in your colon. Finding polyps through a colonoscopy and removing them reduces your cancer risk. Anal cancer is less common but also curable when diagnosed early.
Among the 1.2 million people in the U.S. infected with HIV, about half of men and a fifth of women have HPV-related changes in the cells of the anus—some of which may take years to develop into anal cancer.
While the New York State Department of Health recommends a baseline annual anal cancer screening for many HIV-infected men and women, there are no national screening guidelines. The availability of screening also differs throughout the country—our practice is one of the few who offer screenings in New York City.
So what can you do if you feel you’re at risk?
Get past your embarrassment and have a doctor perform an anal Pap smear.
The incidence of cervical cancer has diminished significantly due to the advent of Pap smears, and since HPV affects the anus in the same way it affects the cervix, any person who is at an increased risk for developing anal cancer should have this simple test done. It only takes a minute or two and involves your doctor inserting and brushing a small swab into the anal canal.
The sample is then sent to a laboratory to check for the virus subtypes that cause anal warts, as well as checking for any changes in the cells that make up the lining of the anus. If abnormal cells are present, a high resolution anoscopy (HRA) is warranted. HRA is a procedure that allows doctors to closely inspect the affected tissue in the anal canal. Any abnormal appearing tissues are biopsied and sent to the pathology lab to look for signs or pre-malignant cells or cancer cells which will require further treatment.
If you feel you are at risk for anal cancer, please call our office to schedule an anal pap smear so you can be evaluated.
For more information about the the gastroenterological services offered at Manhattan Gastroenterology, or to schedule a consultation with the GI doctor, Dr. Shawn Khodadadian, please contact our Upper East Side NYC gastroenterology office.