Anal Pap Screening in Gay and Bisexual Men

Increase surveillance needed as cancer rates soar

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For decades, women have had the benefit of a test that helps detect cervical cancer in the early stages of infection. The technology, known as the Pap smear, has saved countless lives by ensuring the early detection and intervention, dramatically reducing the incidence of death in women.

Today, the technology has been expanded to enable the early detection of anal cancer in gay and bisexual men, as well as at-risk women. In general, anal cancer disproportionately affects gay and bisexual men.

What is an Anal Pap Smear?

The anal Pap smear is a test similar to the vaginal Pap smear. During an anal Pap smear, a small sample of cells is collected from the anus and rectum. They are then examined under a microscope in order to identify any structural changes in the cells. These changes can be precursors to anal cancer.

The Link Between HPV and Cancer

Anal cancer and cervical cancer are both associated with the human papillomavirus (HPV), which can cause genital warts. The warts are easily spread from person to person through sexual intercourse.

Gay and bisexual men with HIV are especially at risk because they are at higher risk for persistent HPV infection. Unlike other sexually transmitted diseases, condoms are not entirely effective in preventing the spread of the virus.

Studies show that the incidence of anal cancer is much higher in men who have sex with men (MSM) who are HIV positive, with current evidence indicating that

  • Around 35 of every 100,000 MSM will develop anal cancer.
  • Around 8 of every 100,000 women will get cervical cancer,

Generally speaking, HIV infection itself is associated with a high risk for the development of many types of cancer, both HIV-associated and non-HIV associated.

The Anal Pap Smear Procedure

The anal Pap smear is very quick, painless, and simple. Using a swab with a synthetic tip, a clinician collects cell samples from the anal canal by swabbing all surfaces of the anus and rectum.

These cell samples are then sent to a lab, where technicians examine them under a microscope in order to identify cellular changes which may indicate cancer. Generally, the physician will have the results in just a few days.

To ensure an accurate test, guidelines suggest patients adhere to certain precautions for 24 hours before an anal Pap smear is performed:

  • Do not have receptive anal intercourse.
  • Do not put any creams, lubricants or medications into your anus.
  • Do not insert sex toys or other objects into your anus.
  • Do not douche or use enemas.

Anal Pap Smear Results

If the Pap smear is normal, that's great news! You can sit tight until your next recommended screening.

If the Pap smear is abnormal, the cells in the anal canal will develop pre-malignant changes called intraepithelial neoplasms. These changes gradually worsen. If left untreated, they can develop into invasive cancer.

If abnormal changes are noted in your Pap, your doctor will recommend further testing. If needed, a surgical laser may be used to remove affected tissue.

Screening Recommendations

A growing body of evidence suggests that, for gay and bisexual men, anal Pap smears every two years could identify many cases of anal cancer early—when they are most likely to be treated successfully.

Some clinicians, however, recommend yearly anal Pap smears for men who have sex with men, particularly those with HIV. Neither the Centers for Disease Control and Prevention (CDC) nor the U.S. Preventive Services Task Force (USPSTF) currently offer any recommendations regarding routine anal Pap screening in either men or women.

In addition to men who have sex with men, any persons with a history of anal or vulvovaginal warts (condylomas) should be screened using an anal Pap.

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