Anal Cancer Awareness: New Screening Guidelines for People Living with HIV have been Released
Australia’s first National Anal Cancer Screening Guidelines for people living with HIV were launched earlier this month.
Anal cancer is rare in the Australian population but more common among people living with HIV.
The new guidelines should improve early detection and treatment of this cancer, which can have poor quality of life and life expectancy outcomes if caught late.
What is Anal Cancer and how does it affect people living with HIV?
Anal cancer is caused by certain high-risk strains of human papillomavirus (HPV), which is a common STI. In most cases the immune system clears HPV, but in some individuals, especially those who are immunocompromised, it can persist. Persistent HPV can cause lesions to form in the anal canal, which may progress to high-grade lesions and eventually anal cancer.
If anal cancer is diagnosed early and before it has spread, life expectancy is good. If caught late, it can be a debilitating cancer with a low survival rate.
All people living with HIV are at a higher risk of anal cancer.
The rate of anal cancer is highest for gay, bisexual and other men who have sex with men living with HIV, which is up to 100 times higher than the rest of the Australian population. In this group anal cancer is about as common as prostate cancer is for men generally. Other men living with HIV have about a 32 times higher risk of anal cancer, and women have a 22 times higher risk.
What do the new anal cancer screening guidelines say?
High-risk HPV testing is the primary screening test for anal cancer, with the guidelines also recommending that screening includes physical examinations and a thorough medical history.
The screen should involve a digital anal rectal examination, where the clinician uses a finger to feel for lumps in the anal canal.
Screening for anal cancer should begin at the age of 35 for gay, bisexual and other men who have sex with men and trans women living with HIV.
For ciswomen, trans men and cismen who do not have sex with men anal cancer screening should begin at the age of 45.
Screening should be repeated every three years for people who screen negative.
Screening should be discontinued, with shared decision-making, at age 75 years and in individuals with two consecutive negative screening visits who are not currently sexually active
What can you do?
If you meet the age criteria, we recommend that you speak to your HIV care provider about beginning anal cancer screening.
While the new guidelines should improve awareness among healthcare professionals, anal cancer remains rare in the Australian population. Stigma can also make anal cancer difficult to talk about. This is why you may need to start the conversation with your HIV care provider.
Vaccination provides good protection from the strains of HPV that cause anal cancer but only against new infections. HPV vaccination is not Medicare funded for adults and costs up to $600 for a full course. You should discuss the cost and benefits with your HIV care provider.
Key points
- All people living with HIV are at higher risk of anal cancer, but early detection improves quality of life and life expectancy
- Gay, bisexual and other men who have sex with men and trans women living with HIV should now be screened for anal cancer from age 35
- For ciswomen, trans men and cismen who do not have sex with men living with HIV, anal cancer screening should begin at the age of 45.
- If you meet the age criteria, speak to your HIV care provider about beginning three-yearly anal cancer screens, which involve a test for high-risk HPV, physical examinations and medical history.