1A 5 Baseline Findings from the Anal Cancer Examination (ACE) Study - Acceptability of Digital Ano-Rectal Examination As a Means of Screening for Anal Cancer in HIV Positive Men Who Have Sex with Men

Tuesday, June 10, 2014: 11:25 AM
Grand Ballroom A/B/C/D1
Jason Ong, MBBS, MMed, FRACGP1, Marcus Chen, PhD2, Meredith Temple-Smith, PhD3, Andrew Grulich, PhD4, Philip Clarke, PhD5, Jennifer Hoy, PhD6, Jane Hocking, PhD7, Tim Read, PhD8, Sandra Walker, PhD9, Stuart Cook, GradCert (Public Health)9, Catriona Bradshaw, PhD2, John Kaldor, PhD4, Suzanne Garland, PhD10, Beng Eu, MBBS11, Richard Hillman, PhD12, David Templeton, PhD13, Fengyi Jin, PhD14, Sepehr Tabrizi, MS PhD FFSc(RCPA) FASM15, BK Tee, MBBS16, Chip Farmer, MBBS17 and Christopher Fairley, PhD2, 1School of Population and Global Health, University of Melbourne, Carlton, Australia, 2Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Australia, 3General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Australia, 4Kirby Institute, University of New South Wales, Sydney, Australia, 5Centre for Health Policy, Programs and Economics, University of Melbourne, Carlton, Australia, 6Infectious Disease Unit, Alfred Health, Melbourne, Australia, 7Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia, 8Melbourne Sexual Health Centre, Melbourne Sexual Health Centre, Melbourne, Australia, 9Melbourne Sexual Health Centre Research Unit, Melbourne Sexual Health Centre, Carlton, Australia, 10Department of Microbiology and Infectious Diseases Laboratory Services, Royal Women's Hospital, Parkville, Australia, 11Prahran Market Clinic, Prahran, Australia, 12Western Sydney Sexual Health Centre, University of Sydney, Parramatta, Australia, 13Royal Prince Alfred Hospital, Kirby Institute, Darlinghurst, Australia, 14Kirby Institute, Kirby Institute, Darlinghurst, Australia, 15The Royal Womens Hospital, Parkville, Australia, 16Centre Clinic, Centre Clinic, St Kilda, Australia, 17Colorectal Unit, Alfred Health, Melbourne, Australia

Background:  Anal cancer is the most common non-AIDS defining cancer in HIV-positive men who have sex with men (MSM).  An anal cancer examination (ACE i.e. visual inspection perianally and digital ano-rectal examination) alone is a possible option for early detection but has never been systematically investigated.  

Methods:  The ACE study is a 2-year prospective study of HIV-positive MSM, aged 35 years or older in Victoria, Australia.  Participants will undergo an annual ACE and complete questionnaires at recruitment and after each examination.   Questions included relate to quality of life (SF12), and morbidity associated with ACE. A baseline questionnaire is completed by physicians assessing their experiences and confidence in performing an ACE.

Results:  341 participants have been recruited to date.  At baseline, few participants found the examination painful (1%, 95% CI: 0.2-5) or reported bleeding (2%, 95% CI: 0.4-5).  66% (95% CI: 59-73) were concerned about their cleanliness, 39% (95% CI: 32-47) felt embarrassed, and 16% (95% CI: 10-21) worried about losing control of their bowels.  Despite this, 99% (95% CI:96-100) would undergo another ACE in a year’s time.  Quality of life measures before and after ACE were not statistically significant.  Of 36 physicians, most (86%, 95% CI: 71-95) thought that anal cancer screening was important. 67% (95% CI: 49-81) felt confident in performing an ACE, but only 22% (95% CI: 10-39) were confident in recognizing early anal cancer using ACE.  There was a 4% referral rate to specialists, with one anal cancer detected.

Conclusions:  An ACE is acceptable to HIV positive MSM as a screening method for anal cancer.  Strategies for preparing patients for ACE and further training for physicians, as well as evidence of efficacy are needed if ACE is to become routine practice.