Board: Gynecologists May Treat Men

The American Board of Obstetrics and Gynecology has reversed a September directive that barred its members from treating men for anal cancer. Some gynecologists have been treating men due to expertise gained via cervical pap smears.

Like cervical cancer, anal cancer is usually caused by the human papillomavirus, or HPV, which is sexually transmitted. This type of cancer is rare, but its incidence is increasing, especially among men and women infected with H.I.V. Experts in anal cancer asked the board to reconsider its position, and some started letter-writing campaigns. Patient advocacy groups expressed worry that the prohibition would interfere with research and make it harder for male patients to find screening and treatment. The board had said it wanted to protect the profession as a female specialty and limit the nongynecological work performed by its members. But Dr. Kenneth L. Noller, the board’s director of evaluation, said board members had reconsidered and realized that gynecologists had a long tradition of treating sexually transmitted infections in both men and women, and that HPV and problems related to the virus fell into that category.

Gardasil May Protect Against Anal Cancer

In a small study involving HIV-negative gay men, the HPV vaccine Gardasil was shown to reduce the risk of anal cancer.

The vaccine reduced the risk of lesion recurrence by approximately 50% in the first two years after immunisation. There was some evidence that the protective effects of the vaccine waned after this point. “This is the first study to demonstrate an association between Gardasil after primary disease and decreased risk of recurrent HGAIN [high-grade intraepithelial neoplasia],” comment the investigators, who believe the vaccine may be “an effective post-treatment adjuvant to prevent recurrent HGAIN.” High-risk strains of human papilloma virus are the main cause of anal and cervical cancer. The quadrivalent human papilloma virus vaccine (Gardasil) is highly effective at preventing infection with these strains. Rates of anal cancer are elevated in gay and other men who have sex with men.

As I overshared on Facebook at the time, last month my new doctor surprised me with an anal pap smear, something his practice does routinely for all gay men over 40. My result was thankfully negative, but I mention it here to reinforce how simple and brief the procedure is. Ask for it, regardless of your age. (Tipped by JMG reader Bill)

FDA Endorses Anal Cancer Vaccine

The FDA has endorsed the vaccine Gardasil as a preventive for anal cancer in young men and women. The drug prevents certain strains of HPV (human papillomavirus) which are known to cause various vaginal, penile, and anal cancers. To be effective, the vaccine must be administered at a young age before sexual activity and HPV infection occurs.

Men who have sex with other men are diagnosed with anal cancer at a higher rate than any other population, but in terms of overall numbers, more women get the disease than do men. Women account for approximately 60% of all cases. Like cervical cancer, anal cancer is strongly linked togher rate than any other population, but in terms of overall numbers, more women get the disease than do men. Women account for approximate several types of human papillomavirus (HPV) infections. The Merck vaccine has been shown to effectively prevent the development of HPV in girls and young women, thereby preventing cervical cancer. The anal cancer studies that Merck presented to the FDA showed a similar positive outcome in the prevention of HPV in men.

Christianist groups like the Family Research Council have long opposed the use of Gardasil in pre-adolescent children, characterizing the drug as "the promiscuity vaccine" because it protects against a sexually transmitted disease. The FRC appears to have softened their stance recently, judging by their just-released fact sheet on Gardasil. However they continue to oppose the routine mass vaccination of school children.

(Tipped by JMG reader Bill)

Survey Request From The National LGBT Cancer Network

The National LGBT Cancer Network would like your help.

The National LGBT Cancer Network wants to do something about the increasing prevalence of anal cancer in our community. First, we need to find out what people know about anal cancer. We are asking gay and bisexual men to complete a brief (5-minute) anonymous online survey to assess their knowledge of anal cancer. We are particularly interested in hearing from and hope that you will publicize this request through your blog, listserves, website, mailing lists. The more respondents we have, the more we learn.

In the general population, anal cancer is a rare disease, but among men who have sex with men (MSM), the incidence of anal cancer is 40% higher and increasing annually. However, the majority of gay men know little about the disease, have ever been tested for it, or even know that screening tests exist. Health care professionals, too, remain divided on how and whether to screen for it. In fact, a standardized screening protocol for anal cancer does not yet exist.

To participate, click here.

THANK YOU. To learn more about cancer in the LGBT community and the work of the National LGBT Cancer Network, please visit our website, www.cancer-network.org.

Please consider taking part, it will only take you a few minutes.

UPDATE: JMG reader Band makes the excellent point that you should take the survey before reading the comments on this post, which may influence how you answer the survey's questions. Take the survey FIRST.

Oral Sex Increases Throat Cancer Risk

From New Scientist:

"People who have had more than five oral-sex partners in their lifetime are 250% more likely to have throat cancer than those who do not have oral sex, a new study suggests. The researchers believe this is because oral sex may transmit human papillomavirus (HPV), the virus implicated in the majority of cervical cancers. The new findings should encourage people to consistently use condoms during oral sex as this could protect against HPV, the team says. Other experts say that the results provide more reason for men to receive the new HPV vaccine."

Calling HPV more significant a factor for throat cancer than smoking or alcohol, the study indicates that those infected with HPV have up to a 32-fold increased risk for oropharyngeal cancer. One doctor cautions against panic, saying, "People should be reassured that oropharyngeal cancer is relatively uncommon, and the overwhelming majority of people with an oral HPV infection probably will not get throat cancer."

As I mentioned here recently, some doctors believe that the new HPV vaccine could help prevent anal cancer in gay men. This latest finding should encourage you to be tested for HPV. For most gay men, it is too late. Approximately 95% of all HIV positive men are co-infected with HPV and about 65% of HIV negatives have it as well. But you should still find out. If you are HPV-negative, a $300 or so vaccine seems like a pretty good bargain.

Cervical Vaccine Might Work For Males

The vaccine against human papillomavirus (HPV). which was approved for girls by the FDA last year, might work to prevent anal cancer, for which gay men have an elevated risk. The European Union has already approved the vaccine for use on boys ages 9-15. Considering the outrageous campaign by the American religious right to keep the vaccine from young girls, I imagine that it will a bumpy road getting the vaccine available for boys as well.

The FDA has not yet approved the vaccine for use in males in this country, but doctors here may administer it "off-label" upon request. The vaccine's manufacturer, Merck, is doing a study on its effectiveness against anal cancer, using a cohort that has a large number of gay men. (It was difficult to find gay men eligible for the study because most already have HPV.)

Gay men develop anal cancer about as often as women developed cervical cancer before the advent of the pap smear. Anal pap smears are recommended for gay men over 50. It is estimated that 95% of HIV positive gay men already have HPV, versus 65% for those HIV negative.

Should this vaccine prove effective in males, it will be very important for all of us to advocate strenuously for its speedy approval and its routine, widespread delivery to American boys, which doubtlessly the religious right will fight with 100 times the fervor with which it fought against it being available to girls.
.