Why Are We Not Screening for Anal Cancer Routinely

HIV Physicians' Perspectives on Anal Cancer and Its Screening in HIV-Positive Men Who Have Sex With Men: A Qualitative Study

Jason J Ong; Meredith Temple-Smith; Marcus Chen; Sandra Walker; Andrew Grulich; Jennifer Hoy; Christopher K Fairley


BMC Public Health. 2015;15(67) 

In This Article


Anal cancer occurs at higher rates in men who have sex with men(MSM) than in the general population[1] and with higher rates again in HIV-positive MSM.[2] Rates of anal cancer in HIV-positive MSM have been reported as high as 112 to 144 per 100,000 person years.[3,4] This is more common than other cancers such as colorectal cancer (73 per 100,000 person years) and lung cancer (55 per 100,000 person years) in the general population.[5] Anal cancer is now the most common non-AIDS-defining malignancy in those living with HIV.[6]

Although anal cancer is seen to be important by HIV clinicians, few are actually screening for anal cancer.[7] There are several potential methods of screening being considered. Firstly, given the success with cervical cancer screening using cytology,[8] anal cytology screening to detect the precursor lesion, high-grade anal intraepithelial neoplasia(HGAIN) has been proposed.[9] Secondly, some suggest that those at greatest risk for anal cancer (i.e. HIV-positive MSM) should be targeted with an annual digital ano-rectal examination(DARE) to detect early anal cancer.[9–11] If anal cancer is detected at an early stage, there are survival advantages with 5-year relative survival rates being 78% for localized anal cancer, 56% for regional disease and 18% for metastatic disease.[12,13] Thirdly, a novel means of early detection may be to encourage patients to detect early signs of cancer themselves or with the aid of their partner.[11] Although there is no research to support the efficacy of employing such methods, physicians often describe how patients would present because of an unusual lesion they have found themselves.[14] A further exploration of self- and partner-examination is warranted as they may become a useful adjunct to anal cancer screening.

To date, there are no published qualitative studies exploring the views of HIV physicians regarding anal cancer and its screening. We sought to gain an in-depth understanding of how key HIV clinicians view anal cancer and its screening using the methodologies described above.