Tuesday, June 10, 2014: 11:25 AM
Grand Ballroom A/B/C/D1
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.