Re: anal cytology/pap

[Guest guest]

Hi Margaret,I haven't seen many patients in this population, but from training in NYC, here's what I know:Anal cancer is more prevalent in demographics who practice receptive anal intercourse, this would include homosexual men. Having HIV is a separate risk factor. Subsequently this population (homosexual men or anyone who practices anal intercourse) is more at risk for HPV, which is an independent risk factor. Just like cervical cancer screening, this is a recommended screening in this particular demographic.Hope your patient does well.Soma

From:

Margaret Coughlan ;

To:

< >;

Subject:

anal cytology/pap

Sent:

Fri, Jun 29, 2012 10:42:55 PM

Hello everyone,

I only have a couple of HIV patients in my practice and they get their HIV care from specialist. One gentleman came in today with results of low grade squamous intraepithelia neoplasia on recent anal cytology. My question: does anyone know if this is something we are supposed to do routinely on MSM(gay men) or just ones with HIV.

Thanks for any input.

Margaret

[Guest guest]

I thought I would resend as I have not gotten any responses. Thanks.

Margaret

anal cytology/pap

 

Hello everyone,

I only have a couple of HIV patients in my practice and they get their HIV care

from specialist. One gentleman came in today with results of low grade squamous

intraepithelia neoplasia on recent anal cytology. My question: does anyone know

if this is something we are supposed to do routinely on MSM(gay men) or just

ones with HIV.

Thanks for any input.

Margaret

[Guest guest]

Margaret, I responded to this a few days ago, let me know if you can't find it.Soma

From:

Margaret Coughlan ;

To:

< >;

Cc:

< >;

Subject:

Re: anal cytology/pap

Sent:

Wed, Jul 4, 2012 1:53:44 AM

I thought I would resend as I have not gotten any responses. Thanks.

Margaret

anal cytology/pap

 

Hello everyone,

I only have a couple of HIV patients in my practice and they get their HIV care from specialist. One gentleman came in today with results of low grade squamous intraepithelia neoplasia on recent anal cytology. My question: does anyone know if this is something we are supposed to do routinely on MSM(gay men) or just ones with HIV.

Thanks for any input.

Margaret

[Guest guest]

from the CDC: Currently, there is no routine screening test recommended for other HPV-related health effects, such as genital warts or other HPV-associated cancers (cancers of the vulva, vagina, anus, penis, and oropharnyx). The Pap test does not screen for cancers other than cervical cancer.Screening for anal cancer is not routinely recommended because more information is still needed to find out if screening and follow-up interventions prevent these cancers. However, some experts recommend yearly anal Pap tests to screen for anal cancer in gay and bisexual men

and in HIV-positive persons. This is because anal cancer is more common in those populations. ------------From: http://www.cancer-network.org/cancer_information/gay_men_and_cancer/anal_cancer_hiv_and_gay_men.phpAnal HPV is present in approximately 65% of HIV negative MSMs and 95% of

MSMs who are HIV positive. Although HAART (highly active antiretroviral

therapy) has decreased overall mortality from HIV, it has not reduced the incidence of anal squamous cell carcinoma4.The anus and the cervix are biologically similar and both are target chambers for HPV infection1,2.

The same screening methodology (pap smear) can be used to test the anus

for cancer and pre-cancerous cell changes. A growing number of gay physicians and health activists now believe that routine screening, using an anal pap smear, could reduce the incidence of anal cancer as dramatically as it has cervical cancer in women. They recommend that all

MSMs, especially those who are HIV+, be tested every 1-3 years depending on their immunological well-being and CD4 count. They suggest that HIV negative individuals be tested every 3 years. Still, there are some clinicians who are not convinced that routine screening of all MSMs

is warranted. They cite the small number of positive cases, the shortage of facilities for follow-up procedures and the fear, cost and pain involved in pursuing small cell changes, called dysplasias. In addition, most health insurance policies do not cover anal pap smears.-----------when I've done anal "paps" the report always has the caveat that it is not a screening test for anal changes... looks like maybe for MSMs, one should discuss the pros and cons of screening as it exists now and let them decide.... much like prostate ca screening. To: Cc: < >

Sent: Tuesday, July 3, 2012 7:53 PM Subject: Re: anal cytology/pap

I thought I would resend as I have not gotten any responses. Thanks.

Margaret

anal cytology/pap

Hello everyone,

I only have a couple of HIV patients in my practice and they get their HIV care from specialist. One gentleman came in today with results of low grade squamous intraepithelia neoplasia on recent anal cytology. My question: does anyone know if this is something we are supposed to do routinely on MSM(gay men) or just ones with HIV.

Thanks for any input.

Margaret