Your ass on the line

Are you a back-door man? Then you could be at risk for anal cancer.

Gay men are disproportionately likely to develop this otherwise uncommon condition — but the prognosis for prevention and treatment is good, as long as you’re armed with knowledge and an appropriate level of medical support.

Certain types of human papillomavirus (HPV) can lead to anal cancer. HPV — the world’s most common sexually transmitted infection — can block production of naturally occurring proteins. These proteins protect against the conditions in which anal cancer can arise, according to a report by Toronto cancer researcher Dr Irving Salit.

In particular, abnormal cells called anal dysplasia may appear — and when they cluster into visible lesions, they can become cancerous. Anal play, especially unprotected receptive sex, can expose you to HPV.

“Testing and treatment need to be made more available,” says Duncan MacLachlan, gay men’s outreach coordinator at the AIDS Committee of Toronto. “Gay men’s health needs to be valued equally to teenage girls in Ontario with respect to the provision of the new HPV vaccine.”

MacLachlan is referring to Gardasil, a vaccine that protects against the strains of HPV associated with cervical and anal cancers. The Ontario government launched a campaign this summer to vaccinate young girls before they are sexually active.

Some queer healthcare experts advocate such a proactive approach for queer men, including Dr Richard Loftus, who spoke at an anal-cancer forum in San Francisco earlier this year. Studies haven’t yet conclusively proven that an anal Pap smear — which collects a sample of anal cells to be examined for abnormalities — or the Gardasil vaccine offer benefits to gay men. But that doesn’t matter, Loftus says.

“All gay men should be getting anal Pap smears annually,” Loftus told the forum. He says research so far is promising, and noted that doctors went ahead with cervical Pap smears well before the evidence was in.

How prevalent is anal cancer among gay men? One recent study showed 35 out of every 100,000 gay men had anal cancer. This matches the rate of cervical cancer among women before Pap smears were introduced.

Want to reduce your risks? One strategy is to avoid unprotected receptive anal sex. Condoms don’t completely protect against HPV — because the virus also lives on pubic skin and at the base of the penis, which many not be covered by the condom — but they reduce the risk. Smoking also makes you more likely to develop cancer of the anus (not to mention the lungs!), so try to butt out.

The relationship between HPV, anal cancer and gay men was discussed in the UK medical journal The Lancet as long ago as September 1986. What’s changed since then?

For starters, the rise of the AIDS activist movement permanently changed the relationship between the gay community and the medical establishment. And since then, there’s been a new call for a gay men’s health movement that incorporates — but steps beyond — the long shadow cast by HIV.

Growing awareness of anal cancer points out the paradox faced by queer health advocates today: we can finally give voice to health concerns beyond AIDS, but HIV is still never far outside the frame.

In this case, that’s because according to figures provided by San Francisco’s STOP AIDS project, the numbers of gay men with HIV who have anal cancer are more than double those who are HIV-negative. And while 60 percent of negative guys have anal HPV, for men with HIV that number climbs to 90 percent. Antiretroviral drugs prevent many opportunistic infections, but not anal cancer — so as people with HIV live longer, their risk of anal cancer actually increases.

One of the loudest voices in the new queer men’s health movement was pioneering activist Eric Rofes, who pointed out that even before the advent of AIDS, the lens through which most of the world viewed queer men was that of pathology.

Don’t believe that hype, said Rofes. In his seminal essay “Gay Bodies, Gay Selves,” he countered that “gay men are healthy, happy, and life affirming. We’re creative, strong, and resilient; more than almost any other male population, we think outside the box, take responsibility for our actions, and care for ourselves and others.”

But as Rofes noted, the diseased-and-reckless gay man is still a convenient fallback perspective within and outside our community: gay men are irresponsible, meth-addicted barebackers who can’t control their carnal urges — and who thus deserve all the diseases we can rack up, HIV and beyond.

In this context, it can be hard to discuss health conditions that touch upon our most intimate activities. Many men don’t want to admit they have sex with men — let alone that they allow their assholes to be penetrated. In our society, even after almost 40 years of gay liberation, fewer things are looked upon with more derision. It’s a mistake to underestimate the power of these cultural taboos.

And in the online age of Sex 2.0, so many men can connect with each other for sex without any of the other trappings of queer community. “Gay men tend to be confident explorers of anal pleasure,” says ACT’s MacLachlan, but he adds, “the same is less true of men who do not identify as gay.”

So how do we work together to prevent queer cancers, when some of the men most at risk are the least likely to even know what they are up against? At the personal level, it starts with awareness of the issues, and at very least getting an annual digital rectal exam from your doctor — even if you don’t take it up the butt that often.

Ask your doctor about anal Pap smears. If you don’t feel comfortable, consider finding another doctor if possible, or making an annual trek to a queer health centre in a neighbouring city — such as Toronto’s Sherbourne Health Centre.

And start talking to your friends, loved ones and casual erotic acquaintances about cancer and anal health. The ass you save may be your own — or better still, someone else’s too.