What everyone should know about Human Papilloma Virus (HPV) and anal cancer

Human Papilloma Virus (HPV) and anal cancer

HPV is a common sexually transmitted infection (STI). As John Aravosis has noted previously, HPV has been closely associated with a variety of cancers:

According to the National Cancer Institute, various strains of the sexually-transmitted HPV virus (there are many) cause `virtually all` cervical cancers, `most` (85% of) anal cancers, more than half of all oropharyngeal (mouth and throat) cancers, and half of vaginal, penile and cancers.

(There`s also been a particularly large increase in HPV-caused oropharyngeal cancers in men over the past few decade: `The incidence of HPV-associated oropharyngeal cancer has increased during the past 20 years, especially among men. It has been estimated that, by 2020, HPV will cause more oropharyngeal cancers than cervical cancers in the United States`.)

Not every infection of even the `right` strain will lead to cancer, but `infections that last for many years increase a person’s risk of developing cancer,` according to the National Cancer Institute.

While HPV is associated with a variety of cancers — most famously cervical cancer in women — I’d like to focus primarily in this article on anal cancer.

Gay Men: Anal cancer rates have been increasing in both HIV positive and HIV negative men who have sex with men (MSM). In MSM, anal carcinoma occurs in about 1: 100,000 men, with African-American men having a slightly higher incidence.

Women: Anal cancer can also be found in women who have had anal sex. Possibly the most famous woman to die from anal cancer was 70s icon Farrah Fawcett, who passed away in 2009.

Farrah Fawcett via Featureflash / Shutterstock.com">Shutterstock

Farrah Fawcett. Featureflash / Shutterstock.com

Both men and women can develop genital warts from some types of HPV. And HPV causes cervical cancers in women. There are about 3,000 new cases of anal cancer in women each year, with white women having more anal cancers than other races. And about 2,000 men will be newly diagnosed with anal cancer yearly.

What are the risk factors for developing anal cancer?

Here are some of the risk factors for developing anal cancer:

  • Having HPV: When tested, most anal carcinomas have been shown to be related to HPV. That does not mean that everyone who tests positive for HPV will end up getting cancer.
  • Anal sex: being receptive to anal intercourse (bottoming).
  • Older age: Most anal cancers occur in people over 50 years old.
  • Smoking: Smoking cigarettes has been found to be a risk factor for developing anal cancer.
  • Multiple sexual partners: Men and women who have had multiple sexual partners have a higher risk of developing carcinoma.
  • Drugs and other illnesses: Immunosuppressive drugs and diseases, or conditions that lead to immunosuppression (HIV, post-organ transplant, etc).

The most common symptoms of anal carcinoma are:

  • Bleeding from the anus or rectum
  • Rectal itching
  • Rectal pain
  • A growth (lump or mass) in the anal canal

Unfortunately, these symptoms are virtually identical with the symptoms of a hemorrhoid. Many people assume that the problem is a benign hemorrhoid, that it will will go away in time, and thus don’t seek treatment. This assumption allows the anal cancer to continue to grow and possibly spread.

Prevention of anal cancer

Ways of helping to decrease your chances of contracting anal cancer:

1. The HPV vaccine has been shown to decrease the risk of developing anal cancer. So vaccination is recommended for the prevention of infection.

Recommendations are that girls receive HPV vaccine early, before they become sexually active (around age 12). There is also good information that boys should probably get vaccinated with HPV vaccine at around this age, too.

Some men beyond their teens are getting the vaccinations (there are three shots over a six-month period) as well. John Aravosis recently wrote about getting vaccinated himself.  Keep in mind that if insurance, or some public health agency, isn’t paying for the vaccine, it’s not cheap — all three shots can cost around $500 or more.

2. Practice sater sex

3. Stop smoking

Men (and women) who have been receptive to anal intercourse should be aware of these symptoms of anal carcinoma and get checked for it if they occur. They may also have their physicians check them for signs of anal carcinoma on a regular basis. Examination for anal carcinoma may include: digital rectal exam, anuscopy, ultrasound exam, biopsy or Pap smear. Your primary care physician may do some of these tests on you, or he may refer you to someone who has more expertise and additional equipment available, like a gastroenterologist.

Let your doctor know if you’re at risk of having HPV/anal cancer

Please, make sure to let your doctor know that you may be at higher risk for anal carcinoma. Tell her if you know that you have HPV, if you’ve had receptive anal sex, multiple sex partners, if you’re gay, have symptoms that might be from rectal carcinoma, etc. Your doctor may not think to check for rectal cancer otherwise.

Anal cancer can spread, but slowly, When it does spread, it can be very difficult to treat, and may be fatal.

Which methods are used for treatment will depend on the size of the cancer, whether it’s spread, the patient’s general health, what the patient wants to do, and other factors. Treatment for anal cancer can include any or all of the following: surgery, radiation and chemotherapy.

So, if you meet any of the above criteria putting you at risk of anal cancer, have one or more of the symptoms described above, or just want to have a periodic screening, see your doctor and tell them the reason for your visit.  It could just save your life.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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