Risk of anal cancer looms for those with HIV

Bob says the first indication something was wrong was the blood he found when he used the restroom more than four years ago.

“I thought about going to the doctor, but bleeding stopped,” he says.

But then, a year later, it began again. This time, it didn’t go away.

“It got worse. It was constant. There was blood on my sheets, on my clothes,” Bob says. “I went to the doctor, had a colonoscopy. It turns out there was a cancerous growth in biopsy. It was anal cancer.”

Bob was 46 years old at the time and had been living with HIV for more than 20 years. What he may not have known — what researchers have yet to understand — is how and why his HIV diagnosis made him more susceptible to anal cancer.

According to Dr. Gary Bucher, family medicine physician and anal dysplasia specialist at Advocate Illinois Masonic Medical Center in Chicago, 10 percent of HIV-positive men will develop anal cancer over their lifetimes. And, one in 200 HIV-positive men will be diagnosed with anal cancer this year, he says.

With advances in antiviral treatments making HIV a much lesser death sentence than it was decades ago, scientists are investigating those conditions, like anal cancer, that may further threaten individuals with HIV.

“We’re not sure why there’s a greater risk with HIV,” says Dr. Bucher. “What is clear is that this is a particular population that should be screened regularly for anal lesions, which have been shown to lead to anal cancer.”

In fact, he says he’s one of only a dozen physicians and practices that will be enrolling patients in a nationwide study on the effectiveness of screening for this particular high-risk group. The new research, called the ANCHOR study, will look at men and women who have been identified as HIV-positive and provide screenings for precancerous lesions, much along the lines of a now-standard Pap smear.

The goal is to measure the effectiveness of screening on early detection for the deadly condition. If found effective, the screening could become the standard of care for those with HIV.

The study, which will last five to six years, will enroll 5,000 patients.

“In high-risk patients, we want to screen because there aren’t a lot of good treatments for this deadly form of cancer,” Dr. Bucher says. “Too often, by the time the cancer is found its spread and the patient is already in need of radiation and chemotherapy. The later stages of the disease can be pretty horrendous.”

He says the precancerous cells can be present for years, causing no noticeable symptoms. Later on, like Bob, the cancer can cause minor to considerable bleeding from the rectum. Other signs include pain, itch, irritation and a lump.

And how is Bob doing now?

He’s living cancer-free, though he’s guarded about his chances of a recurrence — something has a 10- to 30-percent chance of happening.

“The lesson here is, no matter who you are sexually, positive or negative, if you notice something different about your body, see a doctor,” Bob says. “They’ll either be able to put your mind at ease or scare the living hell out of you, but get you the treatment you need.”

And if diagnosed, he says to examine all treatment options and be an informed patient.

“Take it seriously, but it’s not a death sentence,” Bob says. “You will get through it, one way or another.”