Asian, Black Men With HIV Less Likely to Get Anal-Cancer Screening

By Reuters Staff

March 18, 2020

NEW YORK (Reuters Health) - Asian men with HIV are much less likely than their white peers to have discussed anal-cancer screening with a healthcare provider, new findings from Canada show.

HIV-positive Asian men and black men were also less likely to report having undergone digital anal-rectal exams (DARE) compared with white men with HIV, Dr. Ann Burchell of St. Michael's Hospital, Unity Health Toronto, and colleagues found.

"Our findings highlight the potential for disparities in anal cancer screening that need to be considered when developing guidelines and screening programs to reduce the burden of anal cancer among men living with HIV and ensure health equity," Dr. Burchell and her team conclude in the Journal of Acquired Immune Deficiency Syndromes.

Anal-cancer incidence for men living with HIV may be as high as 131 per 100,000 people, compared to up to 2 per 100,000 for people not infected with the virus, the authors note. Screening can be performed with anal cytology and high-resolution anoscopy (HRA), they add, but these tests are only available in urban areas. DARE can also be used, particularly if the other two tests aren't accessible.

A total of 1,677 men with HIV from the Ontario HIV Treatment Network Cohort Study (OCS) completed survey questions on anal-cancer screening in 2016-2017. Seventy percent were white; 11% African, Caribbean or black; 4% Indigenous, 7% Asian, 5% Latin American and 4% multiple races.

Twenty-eight percent overall reported being diagnosed with anogenital warts, 14% with human papillomavirus (HPV) and 7% with anal pre-cancer.

Overall, 40% had received anal cytology and/or anoscopy and 80% had received DARE. Asian men had an adjusted odds ratio of 0.48 (95% confidence interval, 0.29 to 0.80) compared with whites for discussing anal cancer screening with a healthcare provider.

They were also significantly less likely to have received DARE (aOR, 0.27), as were African, Caribbean and black men (aOR, 0.47), and cytology/anoscopy (aOR, 0.51).

"At present, both physicians and patients need to navigate significant uncertainty around the benefits of screening and treatment of anal pre-cancer when determining what is best for the individual," Dr. Burchell and her team write. "For providers, this may mean balancing capacity concerns, diagnostic ambiguity and patient anxieties when recommending and conducting anal cancer screening."

They conclude: "Future work should develop and evaluate strategies that address how and to whom providers offer screening, thereby supporting effective and respectful provider-patient communication to help individuals navigate the complex decision-making process."

SOURCE: Journal of Acquired Immune Deficiency Syndromes, online February 21, 2020.