I lost another anal cancer patient this week and I’m getting sick of it. Let’s review some statistics. Anal cancer hits the LGBT community at up to 25 times the national average.
Anal cancer hits HIV survivors 50 to 100 times the national average depending on the study and there are more people living with HIV in Broward County than in any other county in the U.S., and Dade is very near down the list.
Here’s the part that makes me sick. Ninety-Four percent of anal cancers are caused by a VIRUS THAT WE HAVE A VACCINE FOR. Let’s review again this basic premise. There is a cancer that affects our community specifically greater than any other community in the world, and we can stop it, and nobody is doing a damn thing about it?
The Human Papilloma Virus (HPV) is one of the most common infections in the world. Over 90% of all women and men will get at least one type of HPV infection during their life. At any one time, its estimated 80 million Americans are currently infected and up to 14 million adults and teens are infected every year. HPV is spread through simple skin to skin contact, no exchange of fluid is necessary which also means that simple condom use is not enough to prevent transmission.
There are over 100 strains of the virus. The majority of people will clear the virus with the help of a healthy immune system. For some, the virus may lay dormant for decades and resurface later as a wart from a low risk strain or even as a cancer from a high-risk strain.
HPV cancers generally attack all of our holes into our bodies. Anywhere it goes from wet outside to dry inside. HPV is known to be directly linked to the development of penile cancers in men, vaginal, vulvar, and cervical cancers in women, and anal and oropharyngeal (head and neck/ENT) cancers in both men and women.
While there are steps we can take to reduce transmission of the HPV virus, the only real way to prevent it is avoiding all types of physical intimacy including shaking hands, hugging and all sexual contact, manual/oral/ and genital. I think we all know that isn’t going to happen so what else can we do?
- Smoking cessation.
- Practice safe sex
- Stay undetectable if you’re HIV+.
- Any wart, bump, or lump should be evaluated by your primary care doctor and specialist evaluation by dermatology or colorectal surgery as needed.
- Get screened with anal pap smears at appropriate intervals.
These strategies have been shown to stop or decrease transmission of HPV and subsequent development of anal pre-cancer and ultimately anal cancer. Let’s look closer at the vaccine.
The HPV vaccine, the most recent version of which is called Gardasil9 has been administered over 100 million times and the data has consistently shown it to be safe and effective. Originally approved for women up to age 26 in 2006, indication was broadened to include men up to age 26 and just this past year the Food and Drug Administration approved Gardasil9 for use in ALL people up to AGE 45. The vaccine was found to be useful in the prevention of not just anal warts but dysplasia (pre-cancer) and cancer. Although we don’t have the numbers in terms of cancers prevented, there is early data from looking at women with cervical cancer. Among teen girls with the vaccine, HPV infection has decreased by 86%.
There are no specific guidelines for adults, yet I feel we need some given the large anal cancer burden in Southern Florida:
- I believe that all HIV positive people and LGBT people need the vaccine up to age 45. The entire generation of 25-45-year-old survivors have a unique opportunity to boost their chances of living cancer free.
- For HIV negative patients, I believe that men who have sex with more than one man up to age 45 should get it. In addition to multiple partners, anyone who doesn’t use condoms (because they’re on PreP or because their positive partner is undetectable) is also at risk.
- Two other important groups to mention are transplant patients or any other sort of immune system malfunctions besides HIV, should consider vaccination. In addition, any women with a history of vaginal, vulvar, or cervical dysplasia should consider it because they may still be able to protect the anal region.
You should ask your general doctor about the vaccine and if they say you’re too old, bring in this article.
Let’s repeat, the vaccine that could protect you from a virus that could be a major cause of cancer is available free of charge and yet nobody is talking about it.
Let’s do something about it. Let get vaccinated. Let’s not be the number 1 anal cancer county like we’re the number 1 HIV+ county. Not when the solution is so simple, and so easy.
Vaccinated or not, any rectal pain, bleeding, or lesions that persist more than 2 weeks should be evaluated by a specialist. Routine anal pap smears should be performed as well at recommended intervals. Any dysplasia seen during HRA should be treated aggressively.