It’s women’s health week and a wonderful opportunity for women to make their health a priority and be proactive in the healthcare they receive from their doctors. I want to bring our attention to the health of our buttocks and, more specifically, to HPV and its role in anal cancer.
Farrah Fawcett’s battle with anal cancer brought this illness to the minds of women everywhere. Women (and so many of my own patients) who make healthy decisions every day to eat organic, dark leafy greens, practice yoga, meditate and see their doctors yearly for preventative wellness exams were never concerned with anal HPV and cancer. I was rarely asked about anal cancer prior to Farrah’s public acknowledgment. After Farrah’s death, questions about anal cancer and how best to screen for anal cancer became common.
Human papilloma virus (HPV) is well known. HPV is a common sexually transmitted virus which can cause the cells of the cervix to change and, if left unmonitored and untreated, turn into cervical cancer. HPV is also associated with other cancers, including, cancer of the penis, vulva, vagina, throat, and anus. There was a 3-fold increase in the incidence of anal cancer between 1973 and 1998. In 2012, there were 6,230 new cases and 780 deaths from, anal cancer.
Major risk factors identified for anal cancer include:
- Anal intercourse
- IV drug use
- Abnormal pap smears
- HIV infection
- Anal HPV
Women must raise their concerns about screening for anal cancer with their doctors. Unfortunately, at this time, there are no established guidelines for routine screening for anal HPV and anal cancer. As a result, these screenings are often omitted from annual exams. Many doctors are unsure of how to screen for anal cancer. Anal pap smears do exist, but they are not FDA approved. There is also a lack of accuracy in anal pap testing – with sensitivity and specificity fluctuating from 40% to 95% with repeated specimen collection.
So what should women and their doctors do to screen properly and prevent anal cancer? Know your risk factors and discuss them with your doctor. In addition, I recommend digital rectal exams and anal pap smears in the following women:
- Any woman who has HPV and engages in anal sex. Most likely, her male partner has the HPV virus which increases the chance of the HPV virus transferring to anal cells.
- Any woman with a history of HPV or cervical dysplasia who is immunosuppressed due to HIV or having had an organ transplant.
We are at a time where anal HPV screenings are not standard of care. Pap smears, mammograms, colonoscopies and checking for anemia, for example, are other screening tests that most doctors know when to start testing and how often. This is not the case with anal pap smears. Screening is left up to a doctor’s clinical judgment. If your doctor does not bring the subject up with you, I encourage you to approach your doctor and ask whether anal HPV screening is appropriate for you. Although anal pap smears are not, at this time, absolutely accurate, their success at detecting cancer far exceeds doing nothing.