Updated: 2 March 2005

Homosexual men are at risk for anal cancer. Studies evaluating periodic screening with anal pap smears in homosexual and bisexual HIV positive men suggest that they are of similar cost effectiveness as other accepted prevention programs, in terms of detecting pre-invasive intraepithelial neoplasia, reducing the incidence of anal cancers, and downstaging the disease at diagnosis ³. Screening the general population is not considered to be cost effective as the incidence in the general population is low (1.5% of gastrointestinal malignancies). Patients with high grade dysplasia or in-situ disease on screening should be referred for colposcopy and laser therapy.

Patients with anal dysplasia or carcinoma in situ should be referred for assessment and follow up at the anal dysplasia clinic at St. Paul's Hospital where the appropriate diagnostic and therapeutic equipment is available.

Reference:

1. Goldie SJ, Kuntz KM, Weinstein MC, et al, The Clinical Effectiveness and Cost-effectiveness of Screening for Anal Squamous Intraepithelial Lesions in Homosexual and Bisexual HIV-Positive Men. JAMA 1999; 281:1822-9.