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Monday 08 November 2010


Gay men are at risk of anal cancer, studies say

Posted in: Living Well
By Craig Young - 14th March 2010

Human Papillomavirus (HPV) is a highly infectious sexually communicable disease, for which a vaccine is now available to NZ women… but not yet for Kiwi gay men, who are also particularly at risk.

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Earlier this month, Xtra Canada columnist Shawn Syms noted that unlike New Zealand to date, an anti-HPV gardasil prophylactic injection is now available for boys and young men (9-26), as opposed to girls (12-15) alone in our specific context.

HPV often leads to either genital warts or anal, genital and throat cancers. Gay men are seventeen times more likely to develop anal cancer, with HIV+ men even more likely to develop HPV-related opportunistic infections if co-infected with one of the more virulent strains of HPV, according to Quebecois oncologist and anal cancer specialist Dr Francois Coutlee, one of the contributors to the clinical study noted above. The Canadian federal government is doing the right thing by providing presexual prophylactic gardasil injections free to nine to twelve year olds before they become sexually active.

However, what about older men? Is it too late for gardasil to remove the subsidiary risk if someone is already exposed to the HPV strains that may precipitate later anal cancer risks and lesions? Have most gay men been exposed to the aforementioned virulent HPV strains? Dr Coutlee is engaged in further research on the question and will report back on the subject at the Montreal International HPV Conference, to be held in July 2010. In Canada, any prophylactic use of gardasil isn't covered by subsidised federal public health coverage.

What is anal cancer? The American Cancer Society tells us that it is found in women and men and usually develops from their early sixties onward. There are Danish and Swedish studies that demonstrate a causal relationship between specific HPV strains, men who have sex with men and universal applicability in the case of subsequent anal cancer. Smoking, HIV-related immunosuppression and multiple sexual partners can exacerbate risk. Early gardasil injections reduce the aforementioned risk, however. So, what is the current context of this debate in New Zealand?

Back in May 2008, the New Zealand AIDS Foundation published two research-based briefing papers on the subject, authored by Tony Hughes and Peter Saxton. Tony and Peter noted that given early detection is essential with any cancer risk, it was advisable to recommend anal pap smears for gay men as part of our regular sexual health checkups, much as women are in the context of cervical screening programmes. Unfortunately, many anal infections are either asymptomatic or otherwise go unnoticed. Eligibility should be restricted to age-specific groups, related to particular HPV strain prevalence and (unfortunately) clinical data, mostly based on European and North American studies. According to one of the latter, gay/bi/MSM men are less likelier to have been exposed to HPV if under twenty five, but HPV strain exposure risk increases amongst an older age cohort (30-34). Thus, early prophylactic gardasil injections make good primary health sense. Current New Zealand data suggests that most of us experience our first anal sex between eighteen to twenty years of age.

They recommend several options. One is universal gardasil access for gay/bi/MSM men under 26, with HPV tests and vaccination available if uninfected. Public subsidisation will affect uptake, with need for a social marketing campaign and intensive attention to younger men (under twenty six), as well as publicising the benefits of regular anal pap smears.

HIV- men may be exposed to HPV regardless of their HIV status. However, HIV infection may increase the risk of developing high-grade anal precancerous lesions, cellular abnormalities and precancerous cellulaqr shifts. As noted in my previous article, London's Freedom Health offers gardasil prophylaxis, and the Sydney International AIDS Society Conference (2007) also advocated for it. As yet, though, any independent gardasil prophylaxis is not government subsidised and will set one back about NZ$300.

Strongly Recommended:

http://www.nzaf.org.nz/files/Briefing_paper_-_HPV_and_anal_cancer_in_gay_and_bisexual_men.pdf

http://www.nzaf.org.nz/files/Briefing_paper_-_HPV_vaccination_in_gay_and_bisexual_men.pdf



Craig Young - 14th March 2010

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