Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Sticking the finger to anal cancer
This year the HIV conference has been dominated by presentations on anal cancer in men who have sex with men, particularly those living with HIV.
A/Prof David Templeton presented the interim findings from the SPANC study, which assessed the utility of cytologic screening for anal cancer.
Dr Jason Ong presented an interesting overview of what clinicians can do currently to screen for anal cancer, given how little evidence we currently have on the usefulness of screening.
Dr Amber D'Souza presented on the epidemiology of anal cancer
Ben Wilcox and Lance Feeney presented on community perspectives and education on anal cancer.
Brad Atkins gave a moving presentation on his personal experience of anal cancer.
Perhaps the key messages are:
- Modelling has shown that anal cancer screening by a digital anorectal examination has shown it to be cost-effective only for HIV-positive MSM over the age of 25. In that scenario, it is currently recommended to perform anorectal examinations annually. However, an argument could be made to offer screening also to those MSM who are HIV-negative.
- Cytologic screening is problematic, in that it lacks sufficient specificity, resulting in a very large proportion of referrals to high-resolution anoscopy.
- We need to offer HPV vaccination to all MSM under the age of 25, and whilst there is no evidence of benefit over the age of 25 it would be reasonable to offer is to those MSM also (keeping in mind the cost to the patient).
- Much more work remains to be done to determine the best strategies to screen for anal cancer in MSM.