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Anal cancer precursors common in homosexual men
  By Will Boggs, MD
NEW YORK (Reuters Health) - As many as one in five homosexual men have anal squamous intraepithelial lesions (ASILs), precursors of anal cancer, according to a report in the June 15th issue of the Journal of the National Cancer Institute.
"There is a high prevalence of anal cancer precursor lesions and anal human papillomavirus (HPV) in this population across all sexually active age groups, confirming early studies of disease prevalence," lead author Dr. Peter V. Chin-Hong, from University of California San Francisco, told Reuters Health.
Dr. Chin-Hong and colleagues investigated the age-related prevalence and risk factors for ASILs in 1262 HIV-negative men who have sex with men (MSM) in four U.S. cities.
The overall prevalence of ASILs was 20%, the authors report, including 15% of men with low-grade SILs and 5% with high-grade SILs. The prevalence was similar for all age groups.
ASILs were significantly more common among men with more than five receptive anal sex partners (compared with fewer than two) during the previous 6 months. Other risk factors included older age at first receptive anal intercourse, injection drug use two or more times per month in the previous 6 months, PCR evidence of an anal HPV infection, and anal HPV infection with increasing numbers of HPV types, the report indicates.
Low-grade and high-grade SILs individually showed similar risk patterns, the researchers note. High-grade SILs were additionally associated with infection with high-risk HPV types alone or in combination with other HPV types. Residence in San Francisco also seemed to confer an increased risk of high-grade SILs.
"Our group for a long time has advocated for systematic screening of individuals at risk for anal cancer including, but not limited to, MSM," Dr. Chin-Hong said. Other at-risk groups include women with other HPV disease, transplant recipients and all HIV-positive men and women.
"More providers need to be trained to do high resolution anoscopy and treatment of anal precancer lesions once detected and confirmed by biopsy," he said.
"One promising strategy will be the HPV prophylactic vaccine," Dr. Chin-Hong added. "Studies of polyvalent vaccines and trials in MSM (for anal disease) are ongoing."
J Natl Cancer Inst 2005;97:896-905.
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