'Screen gay men for cancer'

Gay men could benefit from screening

Screening gay and bisexual men for anal cancer could save lives at a limited cost, research suggests.

Introducing a system similar to those successfully used to identify cervical cancer in women, could be successful because both diseases are caused by the same virus.

Human papillomavirus (HPV) is a sexually transmitted virus and similar smears could be used to identify anal cancer, suggests Dr Sue Goldie, at Harvard School of Public Health.

Figures show that up to 35 gay men per 100,000 develop the anal squamous form of cancer each year - comparable to the 40 women per 100,000 who contracted cervical cancer in the US before the introduction of "Pap" smears.

A similar screening programme would pick up pre-cancerous lesions among high risk, HIV negative men and allow for removal of the lesions and early treatment of anal cancer, said Dr Goldie.

She and colleagues investigated rates of anal cancer among gay men in Seattle and San Francisco.

Dr Joel Palefsky, of the University of California at San Francisco and co-author of a report in the American Journal of Medicine, said: "No-one knew that cervical cancer was preventable before the use of Pap smears became widespread in the 1960s and cut the incidence of the disease by 80%.

"The hope is that a simple, early screening procedure for HPV-induced anal cancer would lead to a similar drop in disease and death."

The authors predict that screening every two to three years would cost around $16,000 per year of life gained, adjusted for quality of life.

Annual breast cancer screening, in comparison, is estimated to cost $120,000 per year of life gained.

Disease pattern

But the authors added: "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 in unique."

Training of medical workers would also be required and more research was needed to determine the best surgical procedures to treat the lesions.

Kate Law, head of clinical programmes at the Cancer Research Campaign, said the recommendation was a "new idea" which "merits further studies".

She added: "Screening can only work if significant numbers take it up. If gay men didn't come for screening, it wouldn't be successful.

"I would imagine that men would be invited through clinics they currently attend, such as STD clinics, or though established networks including the Terrence Higgins Trust, rather than by adverts in GP surgeries."

She said there was debate about the usefulness of screening in some cases - for example breast screening, which does not pick up pre-cancerous lesions, and prostate cancer.