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1st
appeared 20 May 1999
Anal Cancer Screening for HIV-Positive Gay and
Bisexual Men Would Save Lives and Be Cost Effective
Just as the use of Pap smears has led to a dramatic drop in cervical cancer, so screening
for anal cancer among HIV-positive gay and bisexual men would save many lives at a
reasonable cost, according to a new study published in the Journal of the American Medical
Association (JAMA).
The study predicts that use of a simple and inexpensive procedure, comparable to a Pap
smear, would lead to both early detection of pre-cancerous lesions among high-risk men and
allow for early treatment of a type of cancer known as anal squamous cell cancer.
About 35 HIV-negative gay men per 100,000 develop this form of anal cancer every year,
according to available statistics. Among HIV-positive gay men, the rate is estimated to be
about twice as high. By comparison, about 40 women per 100,000 contracted cervical cancer
every year in the US before the Pap smear was in widespread use. Today, only about eight
women per 100,000 get cervical cancer. The hope is that a simple, early screening
procedure for anal squamous cell cancer would lead to a similar drop in disease and death.
"Unlike other cancers in HIV-positive men, this cancer is potentially
preventable," says Joel Palefsky, professor of laboratory medicine at UCSF and senior
author of the JAMA paper. No one knew that cervical cancer was preventable before the use
of Pap smears as a screening aid became widespread in the 1960s, Palefsky adds.
The new study draws on scientific information gained from cervical cancer screening and is
based on epidemiological data from large samples of at-risk men in San Francisco and
Seattle.
The researchers predict that annual anal Pap smear screenings, along with follow-up
biopsies and surgeries for those whose screenings warrant them, would cost about $16,000
per year of life gained, adjusted for quality of life. By comparison, annual mammography
has been reported to cost approximately $120,000 per year of life gained.
According to the study's projections, screening annually would be the most beneficial and
cost-effective strategy. Screening less frequently would be less effective at detecting
cancer or precancerous lesions, while screening more often would provide little added
benefit for its higher cost. The brief procedure involves inserting a swab into the anal
canal and removing it. It causes mild discomfort.
The study does not conclude that practitioners should immediately begin offering the
simple screening procedure.
"This study provides an important piece of additional evidence that anal Pap
screening should be done for this at-risk population," Palefsky says. "However,
before we proceed, we must first replicate the data we have from Seattle and San Francisco
in other populations, to be able to dismiss the possibility that the disease pattern in
these cities is unique."
Also, more health workers will need to be trained, both in performing biopsies when the
screening test shows abnormal cells, and in surgical procedures to treat the precancerous
lesions, the study notes. At present, surgery for this cancer is difficult and expensive.
Leader of the study and first author on the JAMA paper is Sue J. Goldie, assistant
professor of health policy and decision science in the Department of Health Policy and
Management at Harvard School of Public Health.
Links:
UCSF press release
Journal of the
American Medical Association
HIV-Positive Women at High
Risk For Cervical HPV Infection
Source: Wallace Ravven, News
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