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The Anal Pap Smear

What is it? Who needs one? What does it tell me? What do I do next?

What is the anal pap smear?

The pap smear for women was developed in the 1940's. It has been the most reliable way for early detection of cervical cancer. Research has discovered that HPV, human papillomavirus, can cause abnormal changes in cells that may eventually become cancer cells. These are the same cells that are detected with the pap smear. Routine pap smear has reduced cervical cancer rates in the U.S. by 80%. HPV can cause similar cell changes in the anus. So, when a person is infected with HPV in the anus, these cells can also undergo abnormal changes and become cancer cells.

 

Who needs the anal pap smear?

HPV is the most common of std's. It can be spread by skin to skin contact during sex. HPV can be dormant on the penis, but can also make warts or penile cancer (extremely rare). Having HPV does not mean that you will automatically have cancer cells. There are many types of HPV. Your test results will distinguish between the low risk and high risk types of HPV. Rates of anal cancer have been rising dramatically in gay and bisexual men. In gay and bisexual men 65% who are HIV negative and close to 100% who are HIV positive carry HPV in the anus area. At the time of the anal pap smear, a test is done for HPV. The HPV test is FDA approved to be used with the female pap smear to discuss treatment options. Although about 5,000 cases of anal cancer occur in the u.s. each year, the HPV with anal pap smear combination is not yet officially approved for men. The point is this: if you have had anal sex you should get screened. Screening can reduce or prevent the risk of anal cancer in men, just as screening can reduce or prevent the risk of cervical cancer in women.

What does it tell me?

The cytology (tested cells) results from the anal pap smear will detect abnormal cells in the anus. It is not 100% accurate. Sometimes, there may not be enough samples to test, and the anal pap will have to be repeated. It may return as benign (normal), low grade (lsil) lesions, or high grade (hsil) lesions. These areas may come from warts, and probably from HPV. It may show a precancerous lesion, or, it may show cells that are suspicious for cancer. Depending on your results, HRA may be indicated.

 

What do I do next?

HRA is high resolution anoscopy. It is a way of examining and taking a sample of abnormal tissue. This is done by using a special type of microscope and stain solution inside of the anal area. This procedure takes about fifteen minutes in our office. These tissue samples are examined by the pathologist. The pathologist can distinguish precancerous areas from warts or other abormalities. At that point, we can discuss treatment options. Practicing proactive anal health measures will prevent this medical issue. Gay and bisexual men are 4-9 times more likely to develop an HPV-related anal cancer than women are of getting cervical cancer. Remember: HPV is the most common sexually transmitted disease and anal cancer can be prevented. Discuss these medical issues with your friends and with your medical provider. At Dyer GI Clinics, we are always available to discuss any gastrointestinal issues, including those pertaining to proactive anal health.

Talk with Dr. Julia A. Dyer

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