Skip to main content
SpringerLink
Log in

A qualitative investigation among men who have sex with men on the acceptability of performing a self- or partner anal exam to screen for anal cancer

  • Original paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Purpose

Persistent infection with oncogenic human papillomavirus (HPV) is the primary cause of anal cancer, a disease that disproportionately affects men who have sex with men (MSM); however, there is no uniform screening protocol to detect anal cancer. This qualitative study explores whether a self-anal exam (SAE) or partner anal exam (PAE), that includes self-palpation or palpation of a partner’s anal canal, is an acceptable and self-efficacious screening test, which will cue appropriate follow-up care in MSM.

Methods

Twenty-four MSM living in Houston took part in four focus group sessions eliciting their responses to a study teaching them to perform an SAE or PAE (SAE/PAE). Participants were asked about the acceptability and feasibility of executing an SAE/PAE routinely. Thematic analysis of session transcripts was used to identify common patterns in participant responses. Results: Overall, participants expressed self-efficacy for performing an SAE/PAE and voiced a preference for being taught the procedure by a clinician. Participants agreed that they would consult with a clinician if they ever discovered an abnormality while performing an SAE/PAE. A lack of knowledge about anal cancer among MSM may present a barrier to adopting SAE/PAE. In discussing their experience of the exams, some participants suggested that it could become a routine practice for them.

Conclusions

Our findings suggest that SAE and PAE, as a screen for anal cancer, are acceptable and feasible to MSM. Future research should explore attitudes and beliefs of MSM, with the aim of improving anal cancer education and understanding of pathologic findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Cancer Society (2015) Cancer facts and figures 2015. American Cancer Society, Atlanta

    Google Scholar 

  2. Chaturvedi AK (2010) Beyond cervical cancer: burden of other HPV-related cancers among men and women. J Adol Health 46:S20–S26

    Article  Google Scholar 

  3. Nelson RA et al (2013) Changing patterns of anal canal carcinoma in the United States. J Clin Oncol 31:1569–1575

    Article  PubMed  PubMed Central  Google Scholar 

  4. Johnson LG et al (2004) Anal cancer incidence and survival: the surveillance, epidemiology, and end results experience, 1973–2000. Cancer 101(2):281–288

    Article  PubMed  Google Scholar 

  5. American Cancer Society (2013) Cancer facts and figures 2013. American Cancer Society, Atlanta

    Google Scholar 

  6. D’Souza G et al (2008) Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study (MACS). J Acquir Immune Defic Synd 48(4):491–499

    Article  Google Scholar 

  7. Daling JR et al (1982) Correlates of homosexual behavior and the incidence of anal cancer. J Am Med Assoc 247(14):1988–1990

    Article  CAS  Google Scholar 

  8. Diamond C et al (2005) Increased incidence of squamous cell anal cancer among men with AIDS in the era of highly active antiretroviral therapy. Sexually Transmitted Dis 32(5):314

    Article  Google Scholar 

  9. De Vuyst H et al (2009) Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 124(7):1626–1636

    Article  PubMed  Google Scholar 

  10. Nyitray AG et al (2016) Incidence, duration, persistence, and factors associated with high-risk anal HPV persistence among HIV-negative men having sex with men: a multi-national study. Clin Infect Dis 32:314–320

    Google Scholar 

  11. National Cancer Institute. SEER stat fact sheets: anal cancer. http://seer.cancer.gov/statfacts/html/anus.html. Accessed 15 Oct 2016

  12. Markowitz LE et al (2014) Human papillomavirus vaccination: recommendations of the advisory committee on immunization practices (ACIP), in morbidity and mortality weekly report (MMWR). Centers for Disease Control and Prevention, Atlanta

    Google Scholar 

  13. Sachez DM et al (2012) Knowledge of human papillomavirus and anal cancer among men who have sex with men attending a New York City sexually transmitted diseases clinic. Int J STD AIDS 23(1):41–43

    Article  Google Scholar 

  14. Nielsen A et al (2009) Awareness of human papillomavirus in 23 000 Danish men from the general male population. Eur J Cancer Prev 18(3):236–239

    Article  PubMed  Google Scholar 

  15. Newman PA et al (2013) HPV vaccine acceptability among men: a systematic review and meta-analysis. Sex Transmit Infect 89(7):568–574

    Article  Google Scholar 

  16. Wells JS et al (2014) An integrative review of guidelines for anal cancer screening in HIV-infected persons. AIDS Pat Care STDs 28(7):350–357

    Article  Google Scholar 

  17. Simpson S, Turner R (2012) Four decades of anal cancer in Tasmania, Australia: what do the case data tell us? Sex Health 9(3):213–219

    Article  PubMed  Google Scholar 

  18. Chin-Hong P et al (2008) Comparison of patient- and clinician-collected anal cytology samples to screen for human papillomavirus–associated anal intraepithelial neoplasia in men who have sex with men. Ann Intern Med 149(5):300–306

    Article  PubMed  Google Scholar 

  19. Dodge B et al (2012) Rectal self-sampling in non-clinical venues for detection of sexually transmissible infections among behaviourally bisexual men. Sex Health 9(2):190–191

    PubMed  PubMed Central  Google Scholar 

  20. Daniel WJ (2010) Anorectal pain, bleeding and lumps. Aust Fam Physician 39(6):376–381

    PubMed  Google Scholar 

  21. National Cancer Institute (2015) NCI News Note: Multi-center anal pre-cancer treatment and cancer prevention study launched in HIV-infected persons. http://www.cancer.gov/news-events/press-releases/2015/anchor-trial-launch. Accessed 26 Aug 2016

  22. Newman PA et al (2008) Anal cancer screening: barriers and facilitators among ethnically diverse gay, bisexual, transgender, and other men who have sex with men. J Gay Lesbian Soc Serv 20(4):328–353

    Article  PubMed  PubMed Central  Google Scholar 

  23. Darragh TM, Winkler B (2011) Anal cancer and cervical cancer screening: key differences. Cancer Cytopathol 119(1):5–19

    Article  PubMed  Google Scholar 

  24. Ortholan C et al (2005) Anal canal carcinoma: early-stage tumors ≤10 mm (T1 or Tis): therapeutic options and original pattern of local failure after radiotherapy. Int J Radiat Oncol Biol Phys 62(2):479–485

    Article  PubMed  Google Scholar 

  25. American Joint Committee on Cancer (2010) Anus, in AJCC cancer staging handbook. In: Edge SBA (ed) From the AJCC cancer staging manual. Springer, New York, pp 207–218

    Chapter  Google Scholar 

  26. Mlakar B (2009) Proctoscopy should be mandatory in men that have sex with men with external anogenital warts. Acta dermatovenerologica Alpina, Pannonica, et Adriatica 18(1):7–11

    PubMed  Google Scholar 

  27. Nyitray AG, Hicks JT, Hwang L-Y, Baraniuk S, White M, Millas S, Onwuka N, Zhang X, Brown EL, Ross MW, Chiao E (in press) A Phase 2 clinical study to assess the feasibility of self- and partner anal exams to detect anal canal abnormalities including anal cancer. Sex Transm Infect

  28. Ong JJ et al (2016) Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in men who have sex with men living with HIV. J Int AIDS Soc 19(1):20514

    Article  PubMed  PubMed Central  Google Scholar 

  29. QSR International Pty Ltd., NVivo qualitative data analysis Software. 2012, QSR International Pty Ltd.: Cambridge, MA

Download references

Author information

Authors and Affiliations

  1. Department of Management, Policy, and Community Health (MPACH), School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., RAS - E903K, Houston, TX, 77030-3900, USA

    Seyram A. Butame

  2. Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Sylvia Lawler & J. Michael Wilkerson

  3. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Diseases, School of Public Health, Houston, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Joseph T. Hicks, Lu-Yu Hwang & Alan G. Nyitray

  4. Department of Biostatistics, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Sarah Baraniuk

  5. Program in Human Sexuality, University of Minnesota, Minneapolis, MN, USA

    Michael W. Ross

  6. Department of Internal Medicine, Baylor College of Medicine Houston, Houston, TX, USA

    Elizabeth Yu Chiao

Authors
  1. Seyram A. Butame
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sylvia Lawler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph T. Hicks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Michael Wilkerson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lu-Yu Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sarah Baraniuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael W. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elizabeth Yu Chiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alan G. Nyitray
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seyram A. Butame.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Butame, S.A., Lawler, S., Hicks, J.T. et al. A qualitative investigation among men who have sex with men on the acceptability of performing a self- or partner anal exam to screen for anal cancer. Cancer Causes Control 28, 1157–1166 (2017). https://doi.org/10.1007/s10552-017-0935-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-017-0935-6

Keywords

Search

Navigation