Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study

Abstract

Objective: Human papillomavirus-related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV-positive individuals. Although screening programs for high-risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer to determine how best to minimise psychological distress in future programs. Methods:In-depth qualitative face-to-face interviews were conducted with 21 GBM/MSM participating in the "Study of the Prevention of Anal Cancer" in Sydney, Australia, between June 2013 and June 2014. Nonrandom, purposive sampling was used to ensure heterogeneity with respect to HIV status and screening test results. Framework analysis method was used to organise the data and identify emerging themes.Results: Knowledge about anal cancer, human papillomavirus and the link between them was limited. Abnormal screening results affected participants' sense of well-being and were associated with anxiety and concern about developing anal cancer. HIV-negative men receiving abnormal results showed higher levels of distress compared to their HIV-positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety.Conclusion: Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results. Recent works showed that GBM are largely unaware of the link between HPV and anal cancer, with HIV-negative men having lower awareness. 6 Lack of knowledge and recommendations from doctors are the greatest barriers to screening for HIV-positive men. The present study is explorative and pursues potentially fruitful lines of research rather than an overall explanation of the phenomenon. | Sample and recruitmentApproximately 600 men from community-based settings took part to SPANC study. 18 To be eligible, men were aged 35 years or over and reported sex with another man in their lifetime. 18 This age limit was based on the distribution of anal cancer among different age-groups and on the evidence that incidence of anal cancer increases exponentially with age. 19Among SPANC participants, men were purposively selected based on HIV status (positive and negative), age (>50 years and <50 years) and severity of screening results (normal, presence of LSIL or HSIL). Eligible participants were recruited via letter or e-mail by a SPANC research officer who had access to participants' information and contact details. The recruiting process was arm's length from the interviewer.Those who agreed to be contacted were telephoned by the interviewer t...

“That’s Only for Women”: The Importance of Educating HIV-Positive Sexual Minority Men on HPV and High Resolution Anoscopy (HRA)

“… 5 , 26 , 34 , 41 , 44 - 46 When qualitative methods have been used, such as by Apaydin et al (2018) and Russo et al (2017), analysis has broadly focused on patient-, system-, and provider-level factors regarding HRA uptake and adherence, such as patient anxiety, provider expertise, and healthcare system inefficiencies. 47 , 48 …”

“…5,26,34,41,[44][45][46] When qualitative methods have been used, such as by Apaydin et al (2018) and Russo et al (2017), analysis has broadly focused on patient-, system-, and provider-level factors regarding HRA uptake and adherence, such as patient anxiety, provider expertise, and healthcare system inefficiencies. 47,48 Socially constructed gender roles and performed gender have exacerbated disparities in HPV prevention and screening with the feminization of HPV leading to reduced rates of vaccination and screening. 49 Little consideration has been given to the role of gender and sexual orientation as they pertain to either anal cancer screening or HRA, and less is known about these communities' attitudes, perceptions, and beliefs around HPV-associated cancer care.…”

Anal cancer screening and prevention: a review for dermatologists

“…Simultaneously, patients themselves may not be familiar with their own risk for anal SCC and available screening methods, 81 and dermatologists should be equipped to offer important counselling to patients who are at risk and undergo screening. 82 A quality screening test is able to identify, with a high level of accuracy, an early stage in disease for which there are effective and affordable treatments to mitigate progression. While not as accurate as its cervical correlate, anal cytology has been shown to be a viable screening option 11 that, with increased experience, will likely only improve in its ability to identify anal neoplasia.…”

“…Dermatologists may be more likely to see patients at an elevated risk for anal SCC, such as those living with HIV, MSM, and those presenting for management of anogenital warts, yet there is little guidance in the field on how to manage this increased risk. Simultaneously, patients themselves may not be familiar with their own risk for anal SCC and available screening methods, 81 and dermatologists should be equipped to offer important counselling to patients who are at risk and undergo screening 82 …”

A phase II clinical study to assess the feasibility of self and partner anal examinations to detect anal canal abnormalities including anal cancer

“…More than one-third of men reported checking their anus for disease in the past indicating their concern about anal disease and attempts to screen for disease, putatively without instruction on how to do an anal exam. Since lack of knowledge about anal cancer is associated with substantial anxiety after an abnormal screening result, 29 increased anal cancer educational efforts are needed for MSM in addition to education about self-palpation if subsequent studies confirm a high proportion of MSM already self-palpate for disease.…”