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A national randomized clinical trial study – Anal Cancer HSIL Outcomes Research ( ANCHOR) – is currently determining optimal anal precancer management by comparing treatment and active monitoring. We do not yet know how best to manage anal precancer (also known as high-grade squamous intraepithelial lesions) so that anal cancer could be prevented. This creates a major public health concern. In the absence of national screening recommendations, more than 50 percent of these individuals will be diagnosed at stage III or IV, when five-year survival is less than 40 percent. The American Cancer Society estimates there will be 8,200 new anal cancer cases in 2017. If it remains undetected, untreated or inadequately treated, this precancer can progress to anal cancer. HPV typically clears naturally however, under certain circumstances, it might persist longer and might progress to anal precancer. men about one out of two men in the general population has HPV infection. However, this improvement in survival led to an increase in the lifetime risk of developing anal cancer, especially among HIV-positive gay and bisexual men.Īnal cancer is typically preceded by persistent HPV infection that often leads to precancer. Initiation of anti-retroviral therapy in the 1990s greatly reduced the AIDS-related death rate and improved survival. Some in the medical community have identified anal cancer as the next big crisis among HIV-infected gay and bisexual men. We found that age-specific anal precancer management, including post-treatment HPV vaccination, can potentially lead to an 80 percent decrease in lifetime risk of anal cancer and anal cancer mortality among gay and bisexual men. Our study, published today in the journal Cancer, attempts to find a possible solution to prevent anal cancer in HIV-positive gay and bisexual men, using the best available data. However, one of the reasons for the lack of screening guidelines is that anal precancer treatment has not yet been shown to prevent invasive cancer. The objective of screening is to identify and treat these precancers to prevent occurrence of anal cancer. Likewise, HPV infection is also responsible for causing cervical, vaginal, vulvar, oropharyngeal, penile and rectal cancers. HPV infection can lead to the development of anal precancer which, if remains undetected or not adequately treated, may lead to anal cancer. Yet, no national screening guidelines exist for anal cancer prevention in any population.Īnal cancer is predominantly caused by chronic or persistent human papillomavirus (HPV) infection. These men are 100 times more likely to have anal cancer than HIV-negative men who exclusively have sex with women.
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Almost 620,000 gay and bisexual men in the United States were living with HIV in 2014, and 100,000 of these men were not even aware of their infection.