Sunday 20 January 2013

Anal cancer rise in gay men prompts calls for vaccinations

The BMA has called for the HPV immunisation programme to be widened to include gay men, in an effort to tackle ‘alarming’ rates of HPV-related disease.

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.


  1. Unprotected intercourse, whether or anal or vaginal, would carry the same risk (of contractng HPV), wouldn't it? I expect doctors are telling their patients, whether homo or hetero, to use protection at all times.

    Your facts may be right, but you are scaremongering, Peter.

    1. Actually no. The difference relates to the protective effect of the vaginal vs ano-rectal lining.

      The stratified squamous epithelium of the former offers much more resistance to infection. The delicate absorptive pseudo-stratified columnar lining of the latter is much more easily damaged allowing easier access to micro-organisms.

      It's all a matter of what they were respectively designed to accommodate!

      This is why those having anal sex (whether male or female) are at a higher risk of picking up most sexually transmitted infections - not just HPV.

      But HPV is the cancer-predisposer.


  2. Ok, thanks for explaining that - perhaps you should have made this clearer in your text. After all, non-medical folk cannot be expected to know this stuff.

    Still, if they used condoms, they'd be protected I take it?

    1. You might think so but in fact condom failure rates in homosexuals are very high - in a recent study 17% or about one in six reported them.

      So it is a bit like Russian roulette!

      See Condom failure is high - about 17% of users report it - so it's like Russian roulette!



    2. What are the condom failure rates in vaginal sex? Are the failure rates in anal sex significantly higher? In short, does it matter what kind of epithelium is involved? Does the anal epithelium predispose to condoms bursting?

      Unless you can show significantly higher rates of burst condoms in gay men, your argument would apply equally to heterosexuals having vaginal sex.

    3. "condom failure rates in homosexuals are very high"

      So encourage them to use water-based lube as well. Not complicated.


  3. In any case, you cannot seriously hope to change people's sexual behaviour simply by pointing out the risks (of infection and/or cancer).

    Since when have people stopped having sex because they were afraid of "catching something"?! At very most, a health warning from their GP would induce them to wear a condom - maybe. It's not going to lead to asbtinence, for sure. If it did, we'd be a country of virgins.

    Perhaps you could do a separate blog post on the benefits of abstinence for unmarried heterosexuals. Or rather, since few *teenagers* (other than your young son) are likely to be reading your blog, the importance of teaching one's children to abstain until married. Sad to say, most christian parents I know are too afraid to broach the topic with their offspring, inevitably resulting in the children adopting the morals of their peers.

    This would be more to the point than bleating on about the sexual practices of gay people. Promiscuity is a real problem with straight folk, shouldn't you be tackling that first?

    1. I agree it's a big problem - which I have written about before on this blog - but this is a blog post about anal cancer.

    2. HI JAMES

      You are right that I am young, but I'm not a teenager!

      Hope you're well

      Love Jonno


    3. Hello there Jonno,

      Still lurking, I see. Or does your Dad give you updates on what I post? :)

      Yes, I'm very well thanks. And you? Enjoying your stint at Uni, I hope.

      Tell me - do you spread the message of abstinence among your peers at Uni, or are you too embarassed to talk about it? Your Dad seems to have an obsession with homosexuality, but heterosexual promiscuity (especially among University students) is the real problem imo.


  4. Regardless of whether one is gay or straight, if one is strictly monogamous, then there is no earthly chance of catching HPV or any other sexually transmitted disease. No?

  5. As there's a vaccine against HPV, surely the first step is to give it to all twelve year olds rather than trying to target vaccinations. It's a plan that would save a lot of lives in the long run.

  6. I can't help detecting an undertone in this debate. If a woman gets cervical cancer from contact with partner(s) with HPV, there is a notion that it somehow "serves her right" for undertaking morally questionable behaviour. If a man gets anal cancer for the same reason, then the same argument applies. It's his own fault. He knew the risks of his behaviour; now he's paying the price.

    I find such judgmentalism to be profoundly repugnant and unethical. I agree with the poster above who says that people, by and large, have sex with only the dimmest concern for consequences of any sort.

    The final point is (I suppose) that if both boys and girls are vaccinated against HPV, then the prevalence of HPV in both will go down, lessening the chance of HPV transmission to unprotected recipients of either sex.

    I believe wholly in evidence-based medicine. If it can be shown that the HPV vaccine is protective, safe, and cost-effective against anal cancer, it should absolutely be offered to gay men (and possibly all boys). Until the evidence is compelling, we should be patient and not panic. But please, let's have the discussion about this free from any moral undertones about where boys should or should not be sticking their willies!


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