HEALTH: Are you at risk for anal cancer?

You've stepped on the scale, had your blood pressure checked, maybe even had some blood drawn for a medical test.

But for sexually active gay men, the exam isn't complete until the doctor is asked one important question:

"Am I at risk for anal dysplasia?"


The pre-cancerous condition known as anal dysplasia (pronounced dis-pley-zhuh) is present in 56 percent of men who have sex with men, according to the AIDS Education and Training Centers National Resource Center.  The origin of the disease is unprotected anal intercourse with someone who has human papillomavirus (HPV), which is present in 93 percent of men who have sex with men, according to resource center data.

The HPV infection prevents cells from making the proteins that protect the anus from dysplasia and cancer.

Similar to cervical dysplasia found in women, anal dysplasia is the clustering of infected cells in the lining of the anal canal. These cells form lesions which can lead to anal cancer if left undetected and untreated.


The problem is that because of it's location the condition usually cannot be detected with the naked eye and the lesions can't be felt through self-examination.

Many men may not know they have anal dysplasia, according to Dr. Delmar Aitken, a cancer surgeon in Palm Springs, Ca.

"If you're a sexually active gay male then this may be a silent disease," he said. "There's no doubt that there's many men that have this."

Dr. Aitken sees at least three new cases a month in his practice, said Cheree Aitken, his wife and a registered nurse in his office.

Those at highest risk of getting anal dysplasia are gay men who bottom and have multiple sex partners. Others at risk are men who are HIV-positive because of their compromised immune system. As with HIV and other sexually transmitted diseases, condom use during sex is an effective way of preventing anal dysplasia.

The key to preventing full-blown anal cancer is early detection, which is why Dr. Aitken advises gay men to initiate the conversation with their physician.

The first step a physician will take is often an anal Pap smear, which is an anal swab that's examined under a microscope to look for cell changes. An anoscopy, a visual exam of the anal canal using an anoscope with a bright light, may also be performed.

If abnormal changes have occurred, a piece of affected cell tissue may be removed from the canal and biopsied. The biopsy will determine whether a patient has anal dysplasia or rule it out.

If anal dysplasia is diagnosed, treatment varies based on the size of the lesions and whether the condition is low or high grade. Low-grade or low-risk lesions generally are not treated but they are monitored over time for signs of progression.

Treatment for high-grade dysplasia ranges from destroying lesions by burning them with an Infra-Red Coagulator -- an intense beam of light -- to using acid-soaked cotton, to cutting out the affected area through surgery.

Not getting treated could lead to replacing the anus with a permanent colostomy, which is rare, Dr. Aitken said.

"I tell people I'm treating surgically a bad anus is better than a perfect colostomy," he said. "I don't think anyone wants to give up their anus."