Health advice

Why some gay men are getting this test to detect the early signs of a specific cancer

A doctor with a patient
(Photo: Shutterstock)

Have you ever thought of having an anal pap smear? Gay and bi men have a higher risk of getting anal cancer – especially if they bottom during sex. Because of this, many experts believe it worthwhile for men who have sex with men to be screened for the early stages of the disease.

Know nothing about anal cancer screening? Let’s answer a few basic questions!

What is anal cancer?

Well… as the name suggests, it’s cancer of your anus: that’s the hole through which you poop and through which many guys like to get penetrated during sex.

The majority of anal cancers are linked to HPV (human papillomavirus) infection. HPV is also linked to cancers of the cervix, penis, and throat.

Each year, around 14,000 men in the US get HPV-associated cancers – the majority of these are throat-related (over 11,000), with anal cancer accounting for around 2,000 cases.

Compared to other cancers, anal cancer is rare. However, HPV infection is very common. In the US, it’s estimated that around 80 million adults are infected with HPV, and many will never know they have it.

Related: “Behind Closed Drawers” Awareness Campaign Doesn’t Want You To Get Anal Cancer

What increases the risk of anal cancer?

Having HPV makes anal cancer more likely, but as already stated, lots of people have HPV and it won’t develop into anything serious or life-threatening. Receptive anal sex (“bottoming”) and people with multiple sexual partners have an increased risk, while being HIV positive raises the risk significantly further.

A recent US study found anal cancer had risen five-fold in black males in the US from the mid-1980s onwards, but this may be linked to higher rates of HIV in this community. There is also some evidence that smoking is another risk factor.

That study, from the University of Texas Health Science Center in Houston, found anal cancer, and the number of people who die from the disease, more than doubled for adults aged 60–69 between 2001 and 2016. Because of this, the study’s authors believe physicians should regularly offer screenings to those at risk.

So what does an anal cancer screening involve? Does it hurt?

Screening usually involves an anal pap smear. Like a cervical cancer smear, a small swab is inserted into the anus and swept around to pick up cells. These are then analyzed for any early signs of cancer.

A doctor can also insert their gloved finger or a small device inside you to check for any suspicious lumps or potential tumors. And no, neither procedure should be painful.

So this is something that all gay men should have?

There have been no large-scale studies to measure the effectiveness of screening on reducing cancer rates. For that reason, there is no “official” recommendation to get screened. However, most physicians are convinced about the benefits of screening.

Dr Ashish A. Deshmukh was the lead author of the Houston study mentioned above. He believes gay men with HIV should definitely consider it.

“Men who have sex men with men that are HIV infected should certainly speak with their health care professionals for undergoing routine anal examination as these tests have great potential to prevent or early detect anal cancer,” he told Queerty.

Dr Evan Goldstein, founder of Bespoke Surgical, is an expert in gay men’s anal health. He firmly believes it’s something all gay and bi men should consider.

“I am a huge proponent of anal cancer screening for all MSM (men who have sex with men), even though on a literature review with randomized studies, many only support MSM with HIV.

“An appropriate screening is not only an anal pap smear but also a full detailed sexual history, along with both lab work and an internal and external examination with what’s called an anoscope. This should be standard practice and done once a year by an experienced practitioner.”

If someone has had anal warts, does that mean they’re more at risk of getting anal cancer?

Not necessarily, according to Dr Deshmukh. HPV does cause warts, but there are several different forms of HPV and not all can lead to cancer.

“There are no studies suggesting that anal warts can increase anal cancer risk,” he says. “Anal warts are generally caused by HPV types 6 or 11. HPV type 16 is responsible for causing the majority of anal cancers but this infection mostly resolves; however, under certain circumstances, it could progress to cancer.”

He also points out, “the time between HPV acquisition and cancer development is lengthy— it may take at least 15-20 years for this progression to occur.”

How often should you have an anal cancer screening?

Again, as yet, there is little evidence to suggest an optimal screening regimen – such as what age to start screening or how often. However, Deshmukh believes it, “important that high-risk individuals (mainly HIV-infected persons) undergo routine anal examination as an anal examination could early detect tumors when it is curable.”

Goldstein advises his patients that, “Once a year is standard and should be done in the context of an appropriate sexual history, physical exam in and out of the anal cavity, along with an appropriate STD screening.”

Some physicians suggest an annual exam for HIV-positive men and every 2-3 years for those who are HIV-negative after the age of 50, but opinions differ.

What about the HPV vaccine? Would that benefit gay and bisexual men?

Yes – but the younger, the better. Most people become infected with HPV in their teens or early 20s. The vaccine offers protection from the most common forms of HPV that are linked to cancer.

For example, in the UK, all girls aged 12-13 now have the HPV vaccine, and gay men under 45 are also offered it at STI clinics. No nationwide vaccination program exists in the US, although a small handful of states – including Rhode Island, Virginia, and DC – have school-based immunization mandates.

Goldstein believes it’s something all gay men should consider – even if they’re outside the ideal 18-45 age range.

“All men should be vaccinated in that range. In our community, I have seen lots of improvements and benefits even beyond that, specifically in patients who bottom.”

He believes older men may have picked up some types of HPV but not others, so the vaccine may still offer a measure of protection.

What happens if something abnormal is discovered during a screening?

Firstly, just because you’ve found some sort of lump in or around your anus, don’t assume the worst. Hemorrhoids are extremely common and often feel like little lumps – or can mimic the other symptoms of anal cancer, such as bleeding, itching or pain. That said, do speak to a physician if you have any concerns.

If a pap smear or anal exam does indicate cancer or pre-cancerous changes, bear in mind that this particular disease responds well to chemotherapy and radiation when detected early.

Sometimes, even if a screening throws up suspicious results, it doesn’t automatically mean you have cancer. Some medical professionals will advise monitoring the situation or taking a ‘wait and see’ approach.

“Many positive results are still within the normal range and need to be taken into context,” says Goldstein.

“Tears, hemorrhoids, and just plain old bottoming may indeed alter an anal pap smear. Even douching, specifically with the wrong solution and method, can lead to alterations.”

If there’s anything amiss, your physician will be able to recommend further tests to decide on the best course of action.

Related: Be prepared: Older gay men face higher risk for anal cancer