Anal cancer rise in gay men prompts calls for vaccinations
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| Gardasil vaccine and box (Photo credit: Wikipedia) |
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 likelyto 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 associatedwith
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.
Reprinted with permission from Christian Medical Comment.
