Rectal cancer is on the rise for people living with HIV. People with HIV are at 80 times more risk of developing anal cancer than people without HIV.
A national study has been launched, the ANCHORA study, to examine the link between HPV and HIV. The goal of the study is to find the best way to prevent anal cancer.
“ANCHOR” stands for Anal Cancer HSIL Outcomes Research. The study seeks to recruit HIV positive people, screening for High Grade Sqamous Intraepithelial Lesion (HSIL) and randomly assigning them to a group that will receive treatment or be monitored.
Participants will be followed for five years allowing for a conclusion of whether screening and treatment of HSIL are effective strategies in preventing anal cancer.
Human Papilloma-Virus (HPV) is the most common sexually transmitted infection in the United States. HPV is so common that nearly all sexually active men and women get at some point in their lives. In most cases HPV goes away on its own and does not cause any health problem.
But when HPV does not go away, it can cause health problems like genital warts and cancer.
Approximately 79,000,000 Americans are currently infected with HPV. About 14 million people become newly infected each year.
Anal cancer rates are increasing, with an estimated 7,210 people diagnosed in 2014 in the US. Of those 62 percent were women and 38 percent were men, with the highest rate occurring among HIV positive gay men.
HIV positive people are at a higher risk of becoming infected with HPV and once infected, the time from HPV to cancer happens more quickly for those with HIV versus the typical infection rate of 30 to 40 years.
HPV can cause cell changes in the anus and a higher incidence have been found in HIV positive men and women independent of whether they have anal sex.
Anal dysplasia refers more specifically to pre-cancerous lesions most commonly caused by HPV before the condition potentially worsens to cancer.
The pre-cancerous legions caused by HPV, has been typically been treated in the vagina but are now being treated in the anus as well (for both men and women).
No one knew that cervical cancer was preventable before the use of Pap smears became widespread in the 1960s and cut the incidence of the disease by 80 percent, according to Dr. Joel Palefsky, the study’s principal investigator. Like cervical cancer, anal cancer is often symptom free.
Dr. Lisha Wilson, who is the primary care doctor for AIDS Health Foundation here in the Bay Area, serving HIV patients in Oakland and San Francisco, says, “Anal cancer screening is very important; the problem is resources, particularly for uninsured patients.”
Wilson says doctors just don’t do the screening for some patients because if the screening suggests abnormalities, there would be no options to offer due to lack of insurance coverage.
“For those patients who are insured, I screen everyone,” says Wilson. “I think it’s an important disease, an important intervention, that is effective and definitely worthwhile.”
Anal cancer is easiest to treat when caught early, but screening for anal cancer is not routine like screenings for cervical or colon cancer. This is because removing the HPV damaged cells has not been proven to prevent anal cancer.
Both groups will be checked at least every six months, and if any of the HPV damaged cells develop into cancer during the study, they will be treated.
The ANCHOR study in San Francisco is one of 12 sites throughout the U.S. participation in the study. Not only will this saves lives, but third-party payers will be more likely to cover the costs of screening for anal cancer.
The study is looking for male and female candidates, at least 35 years of age, HIV positive never been vaccinated against HPV or treated for anal dysplasia, never had cancer of the anus, vulva, vagina, or cervix.
To take part in the study call: 415-353-7443 or go to http://anchorstudy.org/