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.

About the Anal Pap Smear

The anal Pap smear is a test similar to the vaginal Pap smear insofar as a small sample of cells is collected from the anus and rectum. They are then examined under the microscope to identify any structural changes in the cells. These changes are often identified as precursors to anal cancer, a type of cancer which disproportionately affects gay and bisexual men.

Link Between HPV and Cancer

Anal cancer and cervical cancer are both associated with the human papillomavirus (HPV), the virus of which can cause genital warts that 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, which can manifest with a 40-fold increase in the risk of anal cancer compared to the general U.S. population. And 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 is very quick, painless, and simple. Using a Dacron swab, the 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 prep the samples and examine them under a microscope to identify any cellular changes which may indicate cancer. Generally, within a few days, the physician will have the results and be able to discuss them with you.

To ensure an accurate test, guidelines suggest that patients adhere that certain precautions be taken 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 take enemas.

Screening Recommendations

A growing body of evidence suggests that anal PAP screening in gay and bisexual men 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 MSM, particularly those with HIV. For their part, 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 MSM, any persons with a history of anal or vulvovaginal warts (condylomas) should be regularly screened.

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

If abnormal changes are noted, further investigations are performed and, if indicated, surgical laser excision may be used to remove affected tissue.

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