ANCHOR Study Prevents Anal Cancer From Being a Pain in the Ass

On March 21, National Anal Cancer Awareness Day, there's some news you need to know. Anal cancer rates are rising, especially among people living with HIV. The good thing is, if caught early, it's easily treatable.

The doctors at the 12 cities participating in the Anal Cancer Outcomes Research and Prevention Study (ANCHOR) are now recruiting HIV-positive men and women 35+ years old into a five-year, compensated study. If cancer is found during screening for pre-cancerous anal lesions, they'll be enrolled and randomized to have the lesions either treated or monitored every six months. It's all to help prevent anal cancer.

"We want to study HIV-positive, sexually active MSM and women around 35-45 years old, because we want the potential to study people who might develop cancer," said principal investigator Dr. Gary Bucher. "In general, anal cancer has been a cancer of women."

The procedure isn't a colonoscopy; it's a basic checkup for cancer in the colon. They are looking at the skin outside the body, between the squamous and columnar cells, about an inch into your anus. Where these two cells meet, said Dr. Bucher, is where problems occur. So he swabs some cells, and using a surgical scope, vinegar and iodine, any precancerous lesions become more prominent. He can track to see if they come back as low-grade L Cells or high-grade H cells, who qualify for the study.

Dr. Bucher realizes that a lot of people don't like getting tested, and many don't like doctors or the exams they give. This is a great way to get screened for problems, and if the treatment is successful, to implement it into physicians' standards of care.

Best of all, the study is in 12 major cities, with multiple testing locations in each city. He explained that the cities were chosen because they had three providers that can screen for hi-res colonoscopies, noting that most cities don't even have one such provider. All are certified to do the procedure, and providers doing x-rays are certified from University of California San Francisco. All providers watch special training procedure videos.

"The event is sponsored by the National Cancer Institute Office of HIV/AIDS Malignancy, and the actual protocol chairs are in San Francisco, so they are writing all the protocols," added Clinical Research Specialist Jacklyn Wase, MPH of the Anal Dysplasia Clinic MidWest. "In Chicago, we started recruitment in February, and have 12 other cities across the United States, including Boston, New York City, Los Angeles, Seattle and Miami."

Although anal cancer is rare in the general population, HIV-positive MSM are 80 times more likely to develop it. HIV-positive women are also at risk. Anal cancer is caused by the Human Papillomavirus (HPV), which can cause changes to the skin around and inside the anus. These changes are called "high-grade squamous intraepithelial lesions" or (HSIL).

Wase explained that if screening reveals HSIL, volunteers can move onto the next part of the study, where they will either be treated or actively monitored every six months for five years. Treatment is free, and volunteers will receive $100 per visit compensation.

"The primary objective is to determine whether treating anal HSIL is effective in reducing anal cancer in HIV-positive men and women," said Wase.

And participants don't need to worry that their anal cancer will remain untreated. Dr. Bucher said that they will follow cases very closely, and if the cancer grows, they will get treatment.

"A lot of times, people are seeing physicians who are not screening for this because it's not a standard of care now," said Dr. Bucher. A lot of doctors want to follow evidence-based guidelines, and there aren't any for anal cancer yet. We want to see that data. And this is a perfect way for those doctors who are not screening to get their patients looked at."