#15: Anal Paps and the ANCHOR Trial
COMMUNITY VOICE: Jeff Taylor | HEALTHCARE EXPERTS: Jonathan Baker, PA-C, MPAS; Joel Palefsky MD, CM; Michael M. Gaisa, MD, PhD | COMMUNITY REVIEWER: ***
SHOW NOTES
Anal paps? Butt – what are we talking about?
Anatomy review!
The anus is the end of your digestive tract (AKA: butt hole)
The last part of the large intestine is called the rectum, and the rectum’s door to the world is the anus
Consider it this way: the anus you can see, the rectum is what’s inside.
Pap smear
A lab test where cells (collected off a brush from any body [art) are examined under a microscope for any changes concerning for early cancer
Can be used to describe the procedure as relates to cervical cancer screening (its original use) or anal cancer screening
The technical term for an anal pap smear is “rectal cytology” (or butt cells), in case you want to get fancy about it
Human papilloma virus? Explain.
There isn’t one HPV virus but rather a collection of 100s, a few of which are more likely to cause cancer (those are the one against which we vaccinate, FYI)
What the virus does
Cause warts
Cause cervical cancer (some strains of the virus are more “high risk” for this)
Cause rectal cancer (not the only cause, but the most common one)
What the virus doesn’t do
Cause herpes.
Also not HIV.
Why do you keep talking about HIV on this anal cancer podcast?
HIV can get in the way of the immune system’s usual tools to control human papilloma virus, especially when HIV has gotten rid of someone’s immune system
This means that people living with HIV are at higher risk higher rates of anal and rectal cancer when compared to folks living without HIV
Anal cancer rates are 30% higher in folks living with HIV
HIgher rates as compared to folks living without HIV (citations here: 1, 2)
Why is this a queer health topic?
Queer men - frequently defined in the public health/medical literature as “men who have sex with men” to focus on the risky behavior (anal sex)
Men who have sex with men, HIV status aside, have higher rates of HPV, which elevates rectal cancer risk
Not just bottoms - tops, you too! Studies show similar rates of anal cancer, regardless of how you have sex.
Other queer folks - for example, trans and non-binary folks –are probably also be at higher risk for HPV and therefore anal cancer, but the data on this is, predictably, pretty sparse
Am I someone who should get screened for anal cancer?
Caveat: talk to your provider please. Guidelines change.
Thumbs up on the screening
If you are queer and living with HIV or have decreased immune function – you may be a candidate for screening. See one guideline example of who should consider screening here.
Why? New data (the ANCHOR trial!) shows that for folks living with HIV, having high risk lesions removed can decrease mortality
Folks who might talk to their clinician about whether anal pap smears arre
HIV-negative folks who have sex with cis men or those having receptive anal sex
Diagnosis of HPV elsewhere on the body
For example, if you have a cervix and tested positive for HPV there
Warts are not cancer. However, someone with a lot of large warts may have a precancerous component to those warts
How urgent is all this?
A “precancerous” lesion usually takes about five years to become a cancer.
And not call precancerous lesions progress to cancer – it’s likely on the order of 1% or less.
In the words of Jonathan Baker (our #RectalRockstar), “this is routine primary care”
What to expect when you’re expecting (an anal pap in your future)
Before
Our experts recommended that you do not use your rectum for sex or douche for one to two days prior to having a rectal swab.
“Come as you are” (though if you have an STI in your butt during the time of your scheduled pap, know that folks will want to treat you and then screen at a different appointment)
During
Part of the test may include a rectal exam, where a provider palpates (or feels) for any abnormal lumps or bumps outside, on, or inside the anus
A swab or small brush collects cells from the lining of the rectum, which a pathologist then looks at under a microscope
After
Expect some irritation for at least a couple of days
Could be longer if something else (e.g. a wart) is removed or treated at the same time as the pap
If your anal pap results aren’t normal
Like all tests, anal paps are imperfect. They really only say “normal” or “abnormal” – the medical term for which is “dysplasia”
Means: someone looking at them under the microscope noted abnormal features
Note: this does NOT mean cancer. This means there is a higher chance of, but is not diagnostic of, cancer.
The dysplasia will likely be labeled “low” or “high” risk based on how abnormal the cells appeared
What do I do now?
Low risk dysplasia may include a repeat test in a few months to a year.
High risk dysplasia
Usually prompts follow up with high resolution anoscopy (yes, anus + scope) to further evaluate the area of anus or rectum where a lesion was found and get a larger sample, or biopsy, if needed.
If biopsy is on the table, talk to your provider about expectations around post-procedure pain and what that means for your sex life.
TRANSCRIPT
Taylor: Well, it's, minimally invasive. You know, if you get a needle stuck in your arm, you can get a Q-tip stuck up your butt. It’s - put it in there, kind of swirl it around a little bit to get some cells off the, uh, mucosa and stick it in a tube when you're done. So. Even if you don't like things back there – and you know, I joke with, with gay men that, you know, Lord knows they do a lot more back there and this is nothing in comparison.
[QHP THEME MUSIC STARTS]
Gaby: Welcome to queer health pod QHP is a podcast about queer health topics for sexual and gender minorities.
Sam: My name is Sam. I use he/ him pronouns, and I'm a physician in training to be a primary care doctor.
Gaby: I'm Gaby. She/her pronouns and same job title as Sam.
Richard: I'm Richard and I use he/him pronouns. I'm the medical director of the Pride Health Center at Bellevue Hospital in New York.
Gaby: And you're listening to QHP season 2, episode five: anal pap smears.
[QHP THEME MUSIC ENDS]
Sam: All right, guys. Butt cancer.
Gaby: Let me translate what Sam is saying there. Today, we're talking about cancer in the rectum or anus, and we're talking about some of the things we can do to screen for and prevent it.
Richard: So a little bit ago we heard from Jeff Taylor, an HIV advocate, who's been involved in multiple community advisory boards. And most recently on something called the ANCHOR study.
Sam: We'll come back to the study very soon, but just know it's made a splash in the field of anal cancer.
Richard: Oy – the puns.
Gaby: Our pun game on this episode is very strong so far, and I'm not mad about it.
Richard: So here’s what's on the agenda for this episode. We'll talk anatomy, define the anus, the rectum, and then we'll talk about cancers that can arise in these areas. We'll cover who might consider getting checked, how healthcare providers check, and then we'll dive into the ANCHOR trial, which is an exciting new trial that tells us what to do with the information we get from these anal cancer screens.
We'll also explain how anal cancer has become a topic under the LGBT Q Health umbrella and what healthcare consumers may wanna know about who should get screened and what that process actually means, especially if your butt is a sex organ for you.
Sam: And before we jump into the rear end –
Gaby: – did you mean the deep end?
Sam: Gaby, I think that's a trap. But my point is this, before we get started a few quick words about Queer Health Podcast.
Richard: We are a direct-to-consumer podcast that is made by us for you listeners to help power share health information. A wide audience means more people know about things like swabbing their butts for cancer. So: consider subscribing on whatever podcast app you're using or send this episode to just one friend who you think might wanna hear it.
Gaby: And we have social media.
Sam: Yes, yes, yes. That thing on the computer. @QueerHealthPodis how you can find us on the interwebs. And uh, you can always write me a letter, but I'm not gonna put my address anywhere publicly.
Gaby: I won't say I’m not disappointed, but I do respect your decision to maintain your cat’s privacy.
[TRANSITION MUSIC]
Sam: Let's start with your butt, but first the backstory, or shall we say the rear story.
Gaby: Ugh. God.
Sam: It all starts in the mouth to the throat, to the stomach, and then your small intestine, which then has its glow up somewhere in your abdomen and becomes the large intestine. The last part of the large intestine is called the rectum and the rectum transitions to plein air, as they say. And that is the anus.
Gaby: So for the visual learners out there if you stick your finger up your butt, your finger is touching your anus and is inside the rectum.
Richard: And if you just stuck your finger up your ass at home, please use some soap and water for at least 20 seconds or the length of a happy birthday song.
[TRANSITION MUSIC STARTS]
Sam: And a special shout out to the butt for staying one of the few non-gendered organs we'll talk about on the podcast.
Richard: Here, here
Gaby: Or rear rear?
Richard: No, really here, here.
Gaby: That's actually, it's very good.
[TRANSITION MUSIC ENDS]
Taylor: My name is Jeff Taylor, my pronouns he, him, his I am one of the community reps to the – I was – to the AIDS Malignancy Consortium, which is the group that created the ANCHOR protocol about 15 years ago. I think is when they started it. My journey with an anal health to phrase it broadly began in the mid nineties. I was having some problems in the anal area and doc who looked at it. Wasn't quite sure. You know, at one point I was very sick. I had a full AIDS diagnosis and with down to two T cells.
Sam: So how do we get from an HIV infection to a podcast episode about anal cancer?
Richard: Sounds like something we can get an expert to explain!
Gaisa: I'm Michael Gaisa. I'm a Professor of Medicine at the Icahn School of Medicine, and I direct the anal dysplasia program for the Mount Sinai Health system. And my preferred pronouns are he and him.
Sam: Here's Dr. Gaisa talking about how HIV can make it harder to fend off HPV.
Gaisa: There is an interplay if you will, between the viruses, HIV, and HPV.
Gaby: HPVs reputation is for causing a few infamous friends, cervical cancer, anal warts genital warts, and also today's topic cancer of the anus and rectum.
Gaisa: So if both infections are present the HPV infection puts fuel into the fire. We see higher rates of both precancerous lesions and anal cancer in folks living with HIV.
Richard: Jeff's HIV diagnosis is a key factor since, when untreated or newly diagnosed, HIV infection can cause immunosuppression, which places people at risk for certain diseases. These are usually illnesses that folks with a robust or well working immune system can clear without ever having symptoms.
Gaby: Which is why it's not surprising that less than 1% of anal cancers are diagnosed in folks under 30 and why the majority of those are in people living with HIV.
Richard: And it's this connection, the connection between HIV, HPV and anal cancer that makes this topic so appropriate for Queer Health Podcast.
Gaisa: Unfortunately LGBTQ people are disproportionately affected by HIV. And we know that people living with HIV have higher rates of anal dysplasia and anal cancer. And , many LGBTQ people perceive this as a sex organ - the anus. So it's in that realm of pivotal concern to most people.
Sam: You heard it here first, everyone, the anus is a sex organ.
(Sam’s interpretation of a “sex organ” noise)
Gaby: Yeah, like that, that combination of noises is gonna be so psychologically distressing for me.
Sam: Everyone should know that, yes. Our parents do listen to our deranged sexual puns.
Gaby: Hi dad!
Richard: While we're still tangentially on the topic of H P V, it's worth noting that the virus itself appears in higher frequency in queer communities
Jonathan: What's unique about men who have sex with men –as opposed to just any given person who's engaging in anal sex – is that there's a higher incidence and prevalence of HPV in men who have sex with men. So there's more chance for community exposure. And then of course, anal-specific exposure. So, you know, even if you had a cisgender woman who's having anal sex, she's probably less likely to come in contact with the same amount of anal HPV as men who have sex with men. If we look at a cohort of a group of men who have sex with men and you have a group that only bottoms ever, they never top, and you have a group that only tops – has never, ever, bottomed – the rates of anal cancer, actually, not all that difference. It has a lot to do with just repeated exposure to HPV and a high community prevalence.
Sam: If suddenly the thought of douching popped into your head, that's not a coincidence. You'll remember Jonathan from our first season's first episode, all about douching. He is our rectal rock star
Jonathan: Hi, my name is Jonathan Baker. I use he him pronouns and I'm a PA I've been practicing for 12 years. I have a really big focus on anorectal infectious diseases, including, you know, HPV.
Gaby: So as Jonathan was saying, tops, bottoms sides, no matter how you have sex, your risk for HPV is the same. And so everyone's invited to the anal cancer screening party. Oh, wait, now actually I've just confused myself. Should – should we literally be screening every queer person for anal cancer?
Richard: The guidelines are pretty clear that HIV positive folks and those with decreased immune function should probably be screened for anal cancer if they use their butts for sex.
Gaby: That makes sense. HIV increased risk for cancer. You get the picture.
Richard: After that, the data's a little bit less clear, but possibly those who use their butts for sex – sometimes called men who have sex with men, often describes cisgender gay, bisexual, and queer men who have receptive anal sex. But also probably even though there's thin data for this, It includes trans folks, trans men, trans women, and non-binary folks who use their butts for sex. And last, but certainly not least, anyone who has a cervix who's had HPV on their cervical pap should probably discuss cancer screening with their providers.
Gaby: What that tells me is there's a lot of gray areas. So how do you talk to your patients about this and when you're in the clinic?
Richard: So what this means for me in practice is that if someone uses their butt for sex or has HPV near their butt, they may be at risk for HPV related cancers. What this means, if they have highly functioning immune systems and don't have H I V is unclear, and if we start the process of screening, we may need to do follow up tests that become unnecessary or that could be painful and upsetting for people. And so: what we do is have a risk benefit conversation and ask people, how high is your anxiety around possibly having cancer versus how much do you wanna avoid doing some of these tests and risking having some pain for maybe not that much benefit.
[TRANSITION MUSIC ENDS]
Richard: All right. Back to Jeff newly diagnosed with an HIV infection and still worried about the lump in his anus.
Gaby: Couldn't that lump be a wart?
Richard: It definitely could be.
Taylor: Everybody knows about genital warts, venereal warts. Now they've seen them, they've had them, but they don't really connect to HPV or to cancer.
Sam: So question, do warts mean cancer?
Gaby: I just typed that question into my Google search bar too.
Gaisa: If somebody has anogenital warts, that is not synonymous and not equivalent with having cancer. So let me just point that out very clearly. The vast majority of warty lesions or low grade dysplastic, meaning they don't have a precancerous change. Now in some of the larger warty lesions, there may be components or aspects of the wart that have a precancerous lesion. So if somebody has many and voluminous, large anal genital warts, t hat's kind of always an indication that we should look more closely, I would say. But if you have warts, that doesn't mean automatically that there is cancer. They can increase the risk for contracting STDs, c an increase the risk for contracting HIV, but they're not in and of themselves considered a precancerous condition.
Sam: Anyway, this is all kind of besides the point because for Jeff it was pretty clear that whatever bump he had was not just a wart.
Taylor: My doctor sent me to various specialists, colorectal surgeons at other people to do biopsies and everything came back kind of indeterminate. They couldn't really tell something was not normal, but they couldn't really say definitively what it was. I had heard about Dr. Palevsky. I can't remember where I read about him and his work and that he was promoting that gay men, especially those with HIV get anal pap smears. So I went to my HIV doc and told him about this.
Richard: And who is this Dr. Palefsky?
Gaby: He's kind of a big deal in the anal cancer world.
Richard: He is a big deal in the anal cancer world. We'll let him tell you about himself.
Palefksy: Okay, so I'm Joel Palefsky. I go by he. I am a professor of medicine at the University of California San Francisco, trained in infectious disease and internal medicine. I'm a virologist by training. I did not grow up aspiring to be a butt doctor. Living in San Francisco at the end of the 80s and the early 90s as the HIV epidemic was raging, it became clear to me that we were going to have a problem and that this really needed some attention. And that's kind of how I got into being an anal HPV person.
Richard: So Jeff hears that a pap smear or a collection of cells looked at under a microscope is something that Dr. Palefksy is advocating for in folks who have HIV.
Gaby: When we say pap, we're using the shorthand for a Papanicolau smear. This is a procedure named after a guy called Papanicolau that was first performed in folks with cervixes. The mechanics are pretty simple: samples of cells are collected with a small brush and then examined under a microscope for cellular changes. The kinds of cellular changes that are consistent with what we see in developing cancer.
Richard: Some folks argue, in fact, that anal cancer screening should not be called a pap test because it's done in a different part of the body, but we'll be using that just as a shorthand for that test. And as a reminder, cervical cancer is a cancer that like anal cancer is also caused by the HPV virus. As Jonathan Baker points out, the process of doing a pap gives a lot more information than just what the cells look like.
Jonathan: When I do an anal pap, I do an exam with my finger and I'll look with a scope. And the majority of anal cancers would be detectable with either of those examinations. And so. I can typically reassure the patient sort of at the same time as the pap. Like if this comes back abnormal, we've already looked for an obvious cancer. There's nothing there, but what would be maybe identifying is pre-cancer,
Richard: I want to let Dr. Palefksy emphasize that little detail about having a finger up your butt to look for cancer. It's very important.
Palefksy: The one thing that I feel quite passionately should be done is a regular digital anorectal exam. Because here you are looking for cancer. The pap smears, the high resolution endoscopy, the biopsies. Those are primarily to look for the pre-cancer with the goal of finding them to prevent the cancer. The digital anorectal exam is the cancer screening test where the purpose of that is to feel for hard masses that might indicate the presence of an existing cancer, because it's very potentially valuable to a person to have that cancer caught, particularly when it's asymptomatic and early.
Sam : So it may feel a little extra to have someone examine your butt with their finger, but it's actually a really good way to figure out if there is maybe cancer there.
Gaby: Okay but what if there's nothing on the physical rectal exam but the cells from the anal pap come back with the result of abnormal?
Richard: Just because of pap is abnormal doesn't mean one has cancer.
Gaby: Let's rewind and repeat that. [Sam makes rewind noise]
Just because of pap is abnormal doesn't mean one has cancer.
Gaby: Abnormal just means we can't guarantee it's normal. Not that it's definitively not healthy.
Sam: Well, to quote a famous pop star of our time, I think the cells aren't a girl, but not yet a woman. Or in other words, they're no longer normal mucosal tissue, but abnormal does not mean cancerous.
Gaby: This is where we'd put the song sample – if only we had the copyright, Britney, have your people call our people. That middle state that not yet a girl, not yet a woman situation. The scientific word for that is dysplasia
Gaisa: So anal dysplasia basically pertains to changes within the cellular component of the inner lining of the anal canal and the perianal skin. And one distinguishes between low grade dysplasia – those are changes that are related to HPV most of the times related to low risk or non-cancer causing types of HPV, and those changes usually go away on their own. There are high risk HPV types or oncogenic HPV types that can cause high grade dysplasia and those high grade dysplastic lesions again are something that most people don't feel or have symptoms from, but they have a potential to progress to cancer of the anal canal, a perianal skin, and that's obviously something that we'd like to avoid.
Richard: The key message we wanna send you is that if your pap comes back with dysplasia low or high risk, you're catching things early. There's a lot of time because this is slow growing.
Jonathan: It seems to take about five years for a precancerous area to become a cancer. And it happens probably less than 1% of the time. I think the best data we have is something like one out of 377 of these precancerous areas will actually become a cancer. So the odds are very, very much in your favor and it takes a long time.
Gaby: Which I think is why Jonathan sounds so calm.
Sam: Calm informed manner. Just like how I definitely deal with every weird bump on my body.
Richard: Weird bump into weird place is my entire clinic.
Gaby: [laughter] That's very good.
Richard: But this is where more testing this time with a camera and a biopsy can help.
Jonathan: If that's abnormal and then the patient has high resolution anoscopy, then we can visually see an area that might look different. And then we can take a biopsy of that, where we remove a specific piece of tissue, usually about the size of a seed and no bigger, so we're not removing the whole lesion with that biopsy most of the time. And then they can look at that under the microscope and they can look at the layers of tissue and sort of determined exactly how much dysplasia or abnormal cells there are and how deep that goes. And that is how we grade precancerous areas. So the pap is not specific. The biopsy is, is like definitive. This is what's going on.
Sam: Wait, what did he just say? And should we have put that earlier in this episode?
Jonathan: The anal paps, really a crummy test. It's not specific meaning that it doesn't give us a whole lot of information other than typically being normal or abnormal. Its not sensitive, so it can both miss disease or come back as a false positive, or it looks like something's abnormal and it's not.
Sam: So why would we start with an imperfect test? Well, the test is simple. The test is cheap, and it doesn't come with a lot of procedure related complications.
Richard: Except for, you know, the stress of a positive test result that ends up being a false positive and could lead to more invasive and unnecessary testing.
Sam: Okay, point well taken, but there may be something to redeem the pap smear yet.
Palefksy: There is only one circumstance in which you can believe a pap smear and that's if it shows high grade disease.
Richard: And dear QHP listeners today, tonight, wherever you hit play, we have something very rare, very special, something you've been waiting for.
Gaby: Drum roll.
Sam: It's data! [Applause sound effect]
Richard: Dr. Palefksy is the head researcher on a national trial, the ANCHOR trial, that looked at what to do with anal pap smears, that show high grade disease. And here he is summarizing the study's main question.
Palefksy: Does treatment of the precancerous HSI (high-grade squamous intraepithelial lesions) prevent anal cancer, like treating cervical HSILprevents cervical cancer.
Richard: In other words, how do we deal with the pap smear results that show concerning high grade lesions and people living with HIV? Is it worth treating the area where the cells come from to prevent cancer,
Gaby: Spoiler alert? Yeah. These high-grade lesions when treated reduce the rate of anal and rectal cancer in people living with HIV.
Sam: And within this population of folks living with hIV, there was trans and cisgender folks straight and queer folks. But again, everyone had an HIV diagnosis and we know that that can accelerate the rate of growth of anal cancer, even if HIV is well controlled.
Gaby: So the ANCHOR trial's an important first step to figure out whose abnormal paps need to be acted on. But it's just that it's a first step. We still have lots of questions to answer, particularly for people who don't have HIV, where there isn't this big, fancy new trial. So researchers – I'm waiting.
[TRANSITION MUSIC]
Gaby: We've hopefully convinced you that if you're someone who's at risk for anal cancer, an anal pap might be for you after a conversation with your clinician. So let's talk about what to expect if you do have an anal pap in your future.
Sam: Another way to phrase that is if you're gonna go to the healthcare provider's office and they're gonna stick something up your butt, is there anything you need to do beforehand?
Gaisa: Don't douche. Don't put anything in there. No water hose, no fleet enema, nothing. Come as you are, that's usually the best approach. In terms of anal paps, the recommendation really is you shouldn't have engaged in receptive anal sex with lubrication in there for the preceding 24 hours.
Sam: Come as you are, preferably without any lube in your butt.
Richard: And if come as you are includes an active, sexually transmitted infection, then come as you are to get treated and then come back as you are after getting treated to get the PAP so don't show up with an active STI, cuz it can change your results
Gaby: Or maybe do show up to get, your, you should show – you should go.
Sam: What Richard means is, do show up with an active STI so we can treat it and have you come back to get a pap smear.
Jonathan: If you have something going on, if you have any anal pain from a fissure, a herpes outbreak and STI that you're being treated for, then I would delay it. There's almost no urgency to any of this.This is all screening. And so if you delay your procedure by a week or two, because something's going on, that's absolutely fine.
Richard: Now let's talk about what to expect if you're going for the follow-up procedure for an abnormal pap- the biopsy.
Taylor: You know, done correctly It's a very benign procedure. You've feel a little bit of pressure. You don't have a lot of nerve endings on the inside. So if they need to take a snip for a biopsy, you can't really feel it. Everything is just kind of, you know, pressure and you can feel the moisture of the vinegar and the iodine swaps that use to highlight any areas that might have abnormal cells in them. So yeah, I wouldn't let that scare anyone off
Sam: Snipping, nerve endings, vinegar?
Richard: All questions, which naturally lead to this question: how will this impact my sex life after the procedure?
Jonathan: I think that is part of the controversy of this, So a pap is just that polyester tip swab. It's going to cause an irritation that irritations transient and typically goes away within a couple of hours. It could last a couple of days, if things are sort of irritated to start with, we're doing biopsies that we expect that there might be some discomfort and bleeding for three days, maybe as long as seven days. If we're treating things. Typically that recovery is going to be about seven days to 14 days.
Sam: So a few days out at most, maybe up to two weeks, if something was lasered or cut out and depends on what that size was.
Richard: And depending on who you are in my clinic, I've seen results vary. Some people have had no symptoms afterwards, and some people have found it really uncomfortable to go to the bathroom for a week or two after. It's important to know that that's a possibility and definitely don't plan on sex immediately after.
Sam: Okay, so what about long-term complications?
Jonathan: It's really rare to have any permanent changes. So we don't see like major changes in sensation scarring, pretty unusual with any of these procedures, unless it's repeated over another. And really the patient's facing scarring in have, have typically had 10 or more procedures. And all of those have been really pretty extensive. So for thinking about treating like one little spot, I wouldn't expect a single long-term consequence. The anus is really, really resilient. And, and just to like, sort of put a silly concept to it, like people will get two fists in their anus, like a biopsy of the size of a seed is, is not going to destroy things. I promise. So there, there is definitely a short effect on someone's sex life. There can be sort of a psychological component to it, right? when your sex organ now becomes a medical. A medical organ that has to be dealt with in that matter, it's certainly going to have a psychological effect. But it's really rare that, that this is going to affect someone's sex life. And almost unheard of that, it would significantly affect someone's sex life.
Sam: You actually may even feel more sexy knowing that a healthcare provider has gone in and removed anything that might have looked like cancer or confirmed that there's no risk for that.
Gaisa: To be very clear, the worst thing you can do for the, for the anus is, or for your anus, is t o let it slide and have it developed cancer because once cancer develops there typically is either surgery or most more commonly chemotherapy and radiation and radiation to the butt really does a number on the anus. So there will, after treatment always be no matter how meticulously well it's done to be some degree of stricture and narrowing. And although many people are able to still have receptive anal sex after chemo and radiation therapy for anal cancer. It's definitely the functionality is going to be compromised, somehwat. So if you're worried about you know? Sexual function through screening just remember and bear in mind the worst outcome is cancer that then needs more invasive treatment.
Richard: And while it may not be a sexy process, it hopefully for some people gets them to a place of assurance and confidence that they don't have cancer and that any risk to their behind is now well, Behind them.
Gaby: I am - I'm truly not sure which pun was more obnoxious, but point made. Sometimes healthcare isn't sexy, but it gets you to a place where you can feel sexier.
[TRANSITION MUSIC]
Gaby: All right, kids. That's all we've got for today. Let's bring it home with a recap.
Sam: Once HPVs taken, hold in someone's skin, it can take five to 10 years, even longer for anything like war to develop or for what we talked about called dysplasia to turn into something more concerning.
Gaby: It's why we recommend that certain groups of people with higher risk of HPV, meaning queer folks, specifically queer men, those with HIV or those with HPV elsewhere on their bodies, like their cervixes. Consider getting their butts checked for anal cancer and that's where the anal pap comes in it's a screening test that looks at a few cells taken off of a brush that's been inserted into the anus.
Sam: If the cells are normal under a microscope, you can get screened again, likely in one to three years, if the cells under the microscope don't look normal, the next step is a biopsy or taking a tissue sample rather than just scraping a few cells.
Richard: If the pap is abnormal, it doesn't mean there's cancer. It just means there was an atypical looking cell or unusual looking cell. That can be any number of different things and sometimes even regress on its own. So at the end of the day, we wanna be really clear that if you're gonna have an anal pap you should have a conversation with your clinician first to decide if it's the right test for you. Also, if you're concerned about your sexual pleasure, the biopsies that are taken are often small enough that there shouldn't be any long term complications.
Sam: Today's been a real assterclass, sorry, masterclass in anal pap smears, but I think it's time we get back to Jeff with the last word
Taylor: Knowledge is power, and you've gotta be your own advocate the rest of the world is not looking out for you. You know, fortunately this is going to become standard of care and people will hopefully very soon have access to this, but any aspect of health. got to be attuned to what's going on with your body and and address it. That's how we stay alive with hIV.
[QHP THEME MUSIC STARTS]
Richard: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks. Thank you so much to our community voice Jeff Taylor and our healthcare experts. Dr. Palefksy, Dr. Gaisa and physician assistant John Baker.
Sam: We would also like to thank our community reviewer, Gary Goldman.
Gaby: For more information on this episode's topic, check out our website, www.queerhealthpod.com. And also help others find this information by leaving a review or subscribing on Spotify or Apple.
Sam: Our handle is @QueerHealthPod and thank you to Gaby for explaining what a handle is to me on the Twitters and the Instagrams.
Gaby: Thank you as always to Lonnie Ginsburg who composed our wonderful theme music.
Sam: Opinions on this podcast are own and do not represent the opinions of any of our affiliated institutions. Even though we are physicians, don't use this podcast alone as medical advice instead consult with your own healthcare provider.
[QHP THEME MUSIC ENDS]
Richard: I don't understand the plein air joke. Can someone explain that to me while we're paused?
Gaby: There's no joke. He just wanted to say something French.
Sam: In plain air, because that's where you're.
Gaby: Oh – I – that makes sense.
Sam: Yeah. Well, this is why I have editors.
Gaby: See, I was so stupid. I didn't realize there was a joke. I just,
Richard: It's a little obscure.
Sam: Okay. Edit me down.
Richard: I assumed it was a joke, but it's a little obscure for the French speaking among us. Gaby, ask Laura if she gets the joke and if not, it's struck.
Sam: Yeah, it was sort of like a, a fart French joke, man. Okay. Anyway. [Makes sex organ noise]