ASHM Report Back
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.
Do you dare?
Dr Jason Ong:Monash Uni,The Alfred,MSHC
On Prevention of Anal Cancer in Gay and Bisexual men:the current state of play and future directions
Excellent series of sessions
This session highlighted that we must reflect on some of the changing practices of rapid testing ,increase testing ,self testing and remember the need for clinical examination also: LOOK
HPV VACCINE :THE GAME CHANGER
But a cohort has missed out
Do we adopt cervical screening protocol and do "chap smears"
Highlighted the key difference with anal Ca and cervical Ca although both SCC
Anal pap larger area,harder to identify lesioms in a collapsing environment,
Differing natural history
Differing referral rates,massive need for HRA/not feasible
No one agees best approach
Still no proof treatment assists outcome
.?trace the 30% males with HGAIN
Need better ways to treat,more RCT havent the specialists
Greater than 50% Anal Ca externally visible average lesion 2.9cm HUGE
BUTLess than 10% HIV MSM have annual anal exam
Need early Ca detection model:less than 2cm lesion possibly just excision with no spread or sphincter involvement,no chemo or radiation
Implement anal digital
Based on Wilson and Jungner screening critera
;"GIVING THE FINGER TO ANAL CANCER"his PhD title
Key findings ;all specialists think it is important to screen for anal Ca but arent doing it
Annual DARE study and recommendations
99% clients willing to have annual dare
Dare is cost effective,safe,acceptable
TIME TO Do DARE translating evidence into action
Screen for precursor lesions
RCT FOR DARE unlikely
Jason is running an educational session at the ASHM hub Friday
DO YOU DARE?
Timely as Tasmania Sexual Health are fortunate to have Prof Richard Turner:Colorectal surgeon Royal Hobat Hospital/UTAS
Continuing his research with monitoring HSIL anal paps :HRA ,histology ?treatment for HIV clients and Women with HSIL paps
He has spent time to demostrate DARE to all clinicians and advises annual DARE
The final session by Brad Atkins of his horror story of his diagnoses and treatment of anal cancer and being totally uninformed and underprepared and to be reminded of the STIGMA,embarrasment people feel
Makes it urgent to "AT LEAST LOOK AND PUT YOUR FINGER IN OR YOU WILL MISS IT"
BACK TO THE BASICS.....