ObjectivesAnal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions. MethodsWe offered anal examinations to consecutive homosexual men with HIV infection aged Ն 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule. ResultsOf 142 men who were offered enrolment in the study, 102 [72%; 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3%; 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination. ConclusionsRegular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection. Keywords: anal cancer, human papillomavirus, screening Accepted 12 March 2013 IntroductionAnal squamous cell carcinoma (SCC) is caused by oncogenic types of human papillomavirus (HPV) and is an uncommon cancer in the general community, occurring at a rate of about 1/100 000 per year [1]; however, it is much more common among HIV-positive homosexual men. A meta-analysis estimated the rate of anal cancer in this group to be 78/100 000 per year since the introduction of effective antiretroviral therapy [2].The prognosis of anal cancer is closely related to the size of tumours at diagnosis, and tumours are often diagnosed [3]. A French case series of 69 patients with tumours < 1 cm in diameter had a 100% 5-year cancer-specific survival, and 89% of patients were disease-free at 5 years [4]. In a series of HIV-infected men with anal cancer, men with tumours < 3 cm in diameter had a 5-year survival rate of 95% compared with 0% in those with tumours Ն 3 cm [5]. In a review of 128 cases of anal SCC from an Australian centre, 52% were externally visible at diagnosis, mean tumour diameter was 36 mm and 94% were Ն 1 cm [6]. The high incidence of anal cancer in homosexual men, particularly those with HIV infection, has led several investigators to develop and recommend methods of screening for the precursor lesion, high-grade anal intraepithelial neoplasia (HGAIN), such as anal cytology, high-resolution anoscopy an...
Appropriate bundle of care (perioperative care, surgical timing and surgical technique) can produce excellent results in patients with ECF.
Aberrant crypt foci are microscopic lesions found in the colons of rodents treated with carcinogens, and in patients with premalignant colorectal conditions. They consist of single or multiple abnormal crypts and show cellular changes ranging from dysplasia to microscopic adenomacarcinoma. It is thought that these lesions represent the initial stages of the adenomacarcinoma path that results in the development of colorectal neoplasia. We have examined the effect of sulindac and indomethacin on the formation of aberrant crypt foci in rats treated with dimethylhydrazine (DMH). Aberrant crypt foci were induced in male Sprague-Dawley rats with two oral doses of dimethyl hydrazine at 25 mg/kg per dose. Rats were randomized to receive sulindac at 3 mg/kg (n = 20) or 10 mg/kg (n = 18) b.d., indomethacin at 1 mg/kg per day (n = 18) or 2 mg/kg per day (n = 19) or control (n = 37). Drug treatment was started on the day following the first dose of carcinogen and continued for 3 weeks. Colons were fixed flat overnight in 10% formalin and stained with 0.2%. Methylene Blue solution before being studied. There was a significant reduction in the number of aberrant crypt foci in rats treated with 10 mg/kg b.d., sulindac (P = 0.001) and indomethacin at 2 mg/kg per day (P = 0.0002). Sulindac, at 3 mg/kg b.d., and indomethacin, at 1 mg/kg per day, did not have a statistically significant effect (P = 0.089 and P = 0.052, respectively). None of the drug treatments affected the relative frequency of single crypt vs multiple crypt foci. Previous studies have shown that sulindac and indomethacin will significantly inhibit the growth and development of tumours in DMH treated rats. The current data suggest that one of the pathways of action of NSAID is to inhibit the formation of early preneoplastic lesions.
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