Cancer
Anal Cancer
The anus is the external opening of the rectum (the final part of the bowel). Faeces (also known as “stool” or “poo”) exit the body through the anus. The anus is also an important part of many peoples’ sexuality. The anus has many nerve endings and people of all genders and sexualities enjoy anal sex. Anal cancer usually happens when normal cells lining the anus change into abnormal cells and grow out of control. Some other cancers can affect the anus, such as melanoma, and lymphoma. Although uncommon, anal cancer affects people who are living with HIV at higher rates than the general population, and men who have sex with men (MSM) are at higher risk than other PLHIV. The most common type of anal cancer is called squamous cell carcinoma (SCC), and is almost always related to human papilloma virus infection (HPV), which can cause genital warts, cervical, and other cancers. Risk factors for anal cancer include a higher number of sexual partners, cigarette smoking, genital warts, and more advanced HIV infection. Symptoms of anal cancer include bleeding from or pain in or around the anus, a growth or mass in the anus, discharge or ulceration from the anus, or unexplained itching around the anus. Anal cancers cause symptoms which should alert people to seek advice from their healthcare professional. However anal cancer can be present without any symptoms. Australian anal cancer screening guidelines for people with HIV were released in 2025. The guidelines recommend that all PLHIV over 45, and all MSM with HIV over 35, have an HPV test every three years, and a digital anal rectal exam (DARE) every year. This will ensure that any cancer is detected early and increase the chance that it can be successfully treated. If high-risk strain of HPV is detected, or if there are any abnormalities, further tests may include history taking, anoscopy or a colonoscopy. Your healthcare provider may ask to perform a biopsy to be sure. Sometimes, people need scans, like CT, MRI or PET scans. The treatment and prognosis of anal cancer, depends on the size, location, and whether the lesion has spread. This might include surgery, chemotherapy or radiation therapy. Things you can do to reduce your risk of anal cancer:
Importance for PLHIV50+
Screening + Diagnosis
Breast Cancer
The primary function of the human breast is to produce milk to feed infants. However, breasts also play an important role in sexuality, identity, society and culture. The breast is made up of a subcutaneous fat, lymph glands, and a series of milk ducts and lobules, that converge at the nipple and areola. The milk ducts and lobules produce milk in response to the hormone, “prolactin”, after child birth. Breast cancer occurs when cells of the breast, usually within the ducts or lobules, begin to grow out of control. Breast cancer is the most common cancer affecting women in Australia, and affects a small number of men too. Trans women, and gender-diverse people are also at a higher risk of breast cancer. Sometimes breast cancer runs in families and certain genes are known to affect a person’s risk of developing breast cancer in the future. Other things can contribute to a person’s risk of developing breast cancer too. These include things like getting older, since 75% of breast cancer occurs in women over 50 years old, exposure to female hormones, either naturally or by taking medications (e.g. hormone replacement therapy); obesity, especially after menopause, excess alcohol intake, smoking, and physical inactivity. Whether people living with HIV (PLHIV) are at higher risk of breast cancer remains unclear, though it is likely to increase as the population of PLHIV ages. In Australia, women are eligible for breast cancer screening mammography every two years from the age of 40-74 years old. The goal is to detect cancer early, and increase the likelihood of successful treatment. BreastScreen Victoria also provides recommendations for trans- and gender diverse people, too. Diagnosing breast cancer as early as possible is important. There are several things you can do to look after your breasts, regardless of your gender. Firstly get to know your breasts by checking your breasts regularly, you might recognise certain changes, which may be a sign of breast cancer. These changes may include: lumps in the breast or armpit, especially if only on one side, changes in the shape of the nipple (e.g. inversion), skin appearance (e.g. dimpling or tethering) or the shape of the breast, new nipple discharge, sores on the nipple, and discomfort or pain in the breast that is not related to your menstrual cycle. If you are concerned about symptoms of breast cancer, speak with your healthcare provider. If you have symptoms, then your healthcare provider may ask to examine your breasts, and arrange further tests, like a mammogram and ultrasound. Sometimes, you may need to be referred to a specialist for a biopsy of the tissue. If cancer is detected, further tests are needed to work out if the cancer has spread beyond the breast, e.g. to the lymph nodes under the arm. Diagnosis and treatment of breast cancer is individualised, but may involve surgery, hormonal therapy, chemotherapy, or radiation therapy, and support from a multi-disciplinary team of people. Things that you can do to reduce your risk of breast cancer:
Importance for PLHIV50+
Diagnosis
Cervical Cancer
The cervix is the lowest part of the uterus (“womb”), and forms the junction between the vagina and uterus in cis-women and some trans-men. The main functions of the cervix include forming the pathway for passage of sperm into the uterus for fertilization, keeping bacteria and other infectious agents out, contraception, and childbirth. The cervix is made up of muscular tissue, blood and lymph vessels. Cancer arises when cells lining the cervix change from normal to abnormal, and grow out of control. The most common form of cervical cancer is called “squamous cell carcinoma”, which is almost always associated with human papilloma virus (HPV). Cervical cancer affects cis-women and trans-men who still have a cervix. It is more common in those over the age of 45. HPV infection is the biggest risk factor for cervical cancer, which is why vaccination is so important. The other major risk factor is smoking. People living with HIV (PLHIV) are also considered more at risk, particularly with lower CD4 counts. Cervical cancer screening aims to detect abnormal cells before they become cancerous, or detect cervical cancer early before symptoms arise. However, symptoms that may indicate cervical cancer include, vaginal bleeding after sex or between periods, pain during sex, unusual vaginal discharge, heavier or longer periods, or bleeding after menopause. If you are worried about these symptoms, please see your healthcare professional. Screening may involve an HPV test or an internal examination. The frequency of this test is individualised. Sometimes, blood tests, biopsies, and other minor procedures are required to sample or remove abnormalities. Treatment will depend on the stage of cervical cancer, how big it is, and whether it has spread, when diagnosed. Treatment may involve a combination of surgery, chemotherapy, and radiation. Things you can do to reduce your risk of cervical cancer:
Importance for PHIV50+
Diagnosis
Bowel cancer
The colon and rectum are two parts of the large intestine (or large bowel), that receive digested food from the small intestine and caecum. The colon absorbs water and nutrients from the faeces, as it is passed to the rectum. The rectum is the last 15cm or so of bowel, which receives waste from the earlier parts of the colon and stores faeces (“stool” or “poo”) before it exits the body, via the anus. Colorectal (also called bowel) cancer can affect any part of the colon or rectum, and becomes more common as people get older. Cancer usually occurs when normal gland cells of the lining of the colon change into abnormal cells, and grow out of control. These are called adenocarcinomas. Often, bowel cancers start as polyps, which are common, and usually harmless. Occasionally, these polyps can become cancerous. Other types of cancers can affect the bowel, like lymphomas, and sarcomas. Bowel cancer affects both men and women and is most common over the age of 50. It affects approximately 1 in every 13 people in Australia in their lifetime, and is more common in people living with HIV. Age and your genes (a family history of bowel cancer) and some medical conditions (e.g. Crohn’s, Ulcerative colitis, type II diabetes), play important roles in determining your risk of bowel cancer. However diet and lifestyle factors can also increase a person’s risk, including smoking, excessive alcohol, obesity, eating lots of red meat or processed foods. Unfortunately, bowel cancer often causes no symptoms and symptoms can be non-specific. Sometimes people experience abdominal pain, a change in their bowel habits, bleeding in their bowel movements, unexplained weight loss or fatigue. A national screening program for colorectal cancer is available, which may help to detect cancer early, and reduce the risk of dying from bowel cancer. In most people, including those living with HIV, it is recommended that people have a screening test every two years, between the ages of 45 and 74 years old. This involves a specimen of faeces, collected at home, being sent away and tested for blood. Some people require earlier, more frequent, or different testing (e.g. with colonoscopy), and it is important that you discuss your individual needs with your healthcare provider. If detected, specialists use additional tests, like scans, to determine if and how far the cancer might have spread. Treatment of bowel cancer is individualised, and often includes surgery to remove the cancer. Some people need chemotherapy or radiotherapy before or after surgery. Things you can do to reduce your risk of colorectal cancer, include:
Importance for PLHIV50+
Diagnosis
Prostate cancer
The prostate gland is found in most cis-men and transwomen and is about the size of a walnut. It surrounds the urethra, which carries urine from the bladder, and lies in front of the rectum, at the base of the penis. The prostate gland plays an important role in sexuality and reproduction, producing fluid that forms part of semen, and being a point of stimulation during sexual intercourse. It is common for the prostate to grow, as men get older. However, prostate cancer occurs when cells in the prostate gland grow out of control. Prostate cancer is the most common cancer in Australian men, besides some types of skin cancer, and affects 1 in 6 men by the age of 85. The major risk factor for prostate cancer is age, with few men under the age of 50 experiencing prostate cancer. A family history of prostate cancer may also increase a person’s risk, along with a strong family history of breast and ovarian cancer. A diet that is high in animal fat, or low in vegetables may increase the risk of prostate cancer. There does not appear to be an increased risk of prostate cancer in people living with HIV, in fact in some studies, it appears to be slightly reduced. Prostate cancer often causes no symptoms, particularly in the early stages. However, people with advanced prostate cancer may experience weight loss, difficulty or changes with urination, blood in the urine or semen, or bone pain – especially in the lower back or pelvis. Unlike bowel, breast and cervical cancers, routine screening for prostate cancer is not recommended routinely, but might be helpful in some individuals. Talk to your healthcare provider about the risks and benefits of screening for prostate cancer. If your healthcare professional suspects that you may have prostate cancer, they may perform some tests to investigate further. The most common tests are a blood test for a prostate specific antigen, and a digital rectal examination. If these suggest changes in the prostate, then you may be referred to a specialist, called a urologist, for an MRI and/or biopsy. If prostate cancer is detected, additional tests may be required to determine where the cancer has spread, which may involve a number of different clinicians in your care. Treatment for prostate cancer depends on how aggressive your cancer is and how far it has spread. Treatment may involve monitoring, surgery, including removing the prostate altogether, radiotherapy, medications that reduce the effect of testosterone on the prostate, or sometimes chemotherapy. Some things that you can do, that may reduce your risk of prostate cancer include:
Importance for people 50+
Diagnosis