There’s one more thing gay men need to know about anal sex and their health: what to do to help prevent anal cancer.
Keith Loukes, a family physician and out gay man, says recent studies have shown a strong link between the human papilloma virus (HPV) and anal cancer.
Loukes says that when HPV, which is part of the family of viruses that causes warts, is contracted on the inside of the body, it can lead to cellular changes that can be pre-cancerous and lead to the development of actual cancer.
“It’s similar to the cancers women develop on their cervix from HPV,” says Loukes.
It’s not just untreated warts that can lead to problems. Even men who have had their warts removed still have the virus in their bodies and face a risk of anal cancer. Men who are HIV-positive, have suppressed immune systems, have frequent sexual partners or who use steroids long-term are especially at risk.
“The big controversy in medicine right now is whether or not to screen all men who have sex with men for anal cancer,” Loukes says. An anal Pap test can check for pre-cancerous cellular changes.
“But the test is very clumsy and few people know how to do it,” he says, adding that the failure rate of the test is as high as 70 percent. There’s also the cost. The “disease burden” is 40 cases of anal cancer per 100,000 men.
“But the numbers are similar for women and cervical cancer and they screen them regularly. So why wouldn’t we do it for men?” he asks.
He says that for the moment a patient can ask for the test and have it done free, but it is not routine and it may not last. “If they start charging for it that will be a real deterrent for some men to get the test.”
Early detection can help prevent some men from developing anal cancer, which may save lives, and that testing should be a priority for HIV-positive people.
Jon-Paul Voroney, an oncology resident at Toronto’s St Michael’s Hospital, says the debate may end up being irrelevant in five years.
“There is a vaccine in trials now that could prevent cancers caused by HPV,” he says. “There’s no guarantee they will work, but there is promise for the near future.”
Warts are spread by direct skin-to-skin contact. The rate of transmission is significantly reduced by using condoms.
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