Sunday 20 January 2013
Anal cancer rise in gay men prompts calls for vaccinations
According to a report this week in Pulse Magazine, Colm O’Mahony, chair of the BMA’s dermatology and venereology subcommittee and BMA public health committee co-chair Penelope Toff have written to health minister Anna Soubry supporting offering the Gardasil vaccine to gay men.
The BMA letter said that although it would be difficult to identify young gay men for a vaccine programme, the HPV vaccine could be administered at genitourinary medicine clinics or community sexual health clinics, perhaps as an add-on vaccination for patients receiving a hepatitis B vaccination.
The letter added that ‘the increasing incidence of HPV and development of anal lesions in gay men, particularly HIV positive gay men, is alarming... We believe that a vaccination programme with Gardasil which included this group would be of enormous benefit in reducing the increasing incidences of anal warts, anal pre-cancers and cancers, as has been borne out in Australia.’
However a Department of Health spokesperson said that there are currently no plans to extend HPV vaccination to males, based on an assessment of available scientific evidence.
What the Pulse article doesn’t do is to enlarge on the little-known link between anal intercourse, HPV and anal cancer.
Here are some facts.
Anal cancer is rare in the general population but its incidence is on the rise for homosexual men.
In the United Kingdom, about 1,100 people are diagnosed with anal cancer each year.
The survival prospects depend very much on the stage at diagnosis but overall 25-40% of people diagnosed with anal cancer will die within five years.
Sexual activity, especially with multiple sex partners, is a recognised risk factor due to the increased risk of exposure to the HPV virus.
Receptive anal intercourse, whether male or female, increases the chances of anal cancer sevenfold due to HPV.
Those who engage in anal intercourse with multiple partners are 17 times more likely to develop anal cancer than those who don't, if their insertive partners are infected with the HPV virus.
The incidence of anal cancer is also ten times higher in the HIV-positive population than in the female population in general.
A 2012 review reports that human papillomavirus 16 (HPV16) is causally associated with approximately 70% of anal cancers and this cancer is markedly increasing among homosexual men.
Based on a study in Denmark and Sweden it is estimated that 90% of anal cancers are attributable to HPV, as HPV types other than HPV16 are also involved.
About 35 in every 100,000 homosexual men develop anal cancer, compared to less than one in every 100,000 heterosexual men.
It's currently unclear whether anal cancer screening benefits men who have sex with men because high-quality studies on this subject are lacking.
These facts are all easily accessible in the public domain to anyone who cares to look but it is very unlikely that you will ever see them reported together. This is partly because the subject is so politically charged.
Anal intercourse is a high risk behaviour which has serious consequences for health. This is equally true whether the 'passive' partner is a man or a woman.
The reason that HPV and anal cancer are so common and rising in the male homosexual population is because of the frequency of anal intercourse and the associated level of promiscuity.
It is of course no longer politically correct to say so, but the male sex organ was beautifully designed for a particular purpose. If one uses it for a purpose other than that for which it was designed then it is not surprising that there are adverse health consequences.
I wonder amidst all the talk about vaccines just how many doctors are as honest with their patients about the cancer risks of anal intercourse as they are about the cancer risks of other high risk behaviours like smoking, obesity, under-exercise and eating too much fat.
I suspect not many. It is an issue where I suspect many doctors are either ignorant, in denial or too afraid to speak.