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The Rise of Anal Cancer Calls for GIs to Expand Awareness, Prevention
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Despite colon cancer being part of our bread and butter routine, I found myself reading this month’s cover story and realizing that anal cancer is a bit of a stepchild within our specialty. Anal cancer is so different from rectal and colon that a lot of us, as gastroenterologists, don’t feel comfortable with it.
This cover story, which originated with our oncology sister publication, allows us to reach across specialties and educate ourselves on how our already-existing role as GIs can help our patients in this newly burgeoning cancer.
Years ago, there was a push within the dental community to not just examine the teeth, but to be aware of the oral cavity and take notice any signs of oral cancers. We should look at this in a similar manner. When you’re examining a patient and performing a digital rectal exam prior to scoping, we need to be cognizant of red flags.
We are positioned to help identify higher-risk patients who need to have an anal Pap smear, such as those patients who have condyloma acuminata.
If you don’t do those smears, you should be educated on where to refer your patients who need one. At Mayo, we have providers in our anorectal surgery clinic who perform ours. Identify in your area who is the local expert and ensure that your higher-risk patients are being screened.
Also of note is that we not only work in an area where we perform physical exams, but many of us work with immunosuppressed patients who may be at higher risk. Just like our female IBD patients who have HPV infection and who are on immunomodulators or biologics have a higher risk for recurrent dysplasia and cervical cancer, someone with anal warts — which are almost always HPV driven — who is also an IBD patient is at a higher risk and may need annual smears.
The Advisory Committee on Immunization Practices of the CDC recommends that all patients aged between 9 and 26 years with immunocompromised conditions or receiving immunosuppressive therapy should get the full course of HPV vaccine. The question perhaps we should discuss further is whether that age range should be extended to others in our purview that may be at risk due to their treatment.
As noted in the cover story, there are huge practice variations on how screening occurs and who is being screened. This is an opportunity for us, as gastroenterologists, to be part of a push to head off the resurgence of anal cancer. When we are doing our normal daily activities, we can be the first line of defense through our observations and our consultations of our patients.
In this issue, we also include a Pro/Con debate. Please let us know how you receive this feature. Join our conversations on Twitter with @HealioGastro and myself @EdwardLoftus2.
Disclosure: Loftus reports consulting with AbbVie, Janssen, Takeda, UCB, Amgen, Pfizer, Salix, Eli Lilly and Mesoblast, and research support from AbbVie, Janssen, Takeda, UCB, Amgen, Pfizer, Genentech, Gilead, Receptos, Celgene, MedImmune, Seres and Robarts Clinical Trials.