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Anal Cancer: Know Your Risk

March 14, 2024

Tufts Medical Center’s José Caro, MD, Division of Infectious Diseases breaks down the stigma associated with anal cancer. Learn who’s at risk and how to prevent this rarely discussed disease.

Jose Caro, MD

What is anal cancer?

People often confuse anal cancer with colon or rectal cancer but they’re unrelated. Anal cancer is caused by the Human Papillomavirus (HPV), it occurs when cancerous cells develop inside or outside of the lining of the anus. When detected early, anal cancer and pre-cancer are very treatable. Unfortunately, it’s often not detected until treatment becomes more difficult due to a variety of factors, including: lack of awareness from physicians and patients, slow development of guidelines for screening and stigma related to HPV and other sexually transmitted infections.

Who is most at risk?

Anybody can develop anal cancer, but the people most at risk are those who are exposed to HPV through sexual contact, particularly if their immune system is compromised. While more women than men develop anal cancer in the U.S., men with HIV who have sex with other men or transgender women with HIV face the highest risks. Other risk groups include women with HIV, heterosexual men with HIV, women with a history of some gynecologic cancers, men who have sex with men, transgender women and transplant recipients. If you belong to one of these higher risk groups, ask your PCP about anal cancer screening

How can you mitigate your risk?

The HPV vaccine decreases the risk of developing all HPV-related cancers, including anal cancer. However, the vaccine is only effective if given prior to exposure to the virus. Because HPV is most often acquired early in most people, frequently after the first sexual encounter, it’s crucial to vaccinate children between ages 9 and 14. The vaccine can still be given up to age 26 if it hasn’t been given before. Older adults may also benefit in certain cases so it’s worthwhile asking your doctor about whether you should receive the vaccine. In addition to getting vaccinated, you can reduce the likelihood of contracting or transmitting HPV by using a condom during sex. We also encourage everyone to quit smoking.

What tests are available + who should be tested?

Colonoscopies will not detect anal cancer. Anal Pap smears and anal HPV testing are the most common and effective tests available. It’s important to note that anal cancer is relatively rare and not everyone needs to be screened. Talk to your PCP about your risk factors and decide together whether you should be screened.

Learn more about testing at the Anal Dysplasia Clinic

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