High acceptability of annual digital (finger) exam for early detection of anal cancer in gay men >35 years old

Simon Collins, HIV i-Base

A poster from a prospective Australian cohort study reported that incorporating simple digital anorectal examinations (DARE) – using a finger – into routine HIV care improved clinical outcomes over two years and had high patient acceptability.

The results were presented as a poster at AIDS 2018 by Jason Ong from LSHTM.

The cohort included 327 HIV positive gay men aged above 35 years from a sexual health centre (n=187), two GP surgeries (n=118) and a tertiary hospital (n=22), all in Melbourne. Median age was 59 (SD +/–8) years, 69% were Australian born, 32% current smokers, and mean CD4 was 630 (SD+/–265) cells/mm3.

Overall, 232 men (71%) received three exams (at baseline and years 1 and 2), 71 (22%) recieved two and 24 (7%) had one result.

Of 862 DAREs performed, 33 (3·8%) examinations resulted in a referral to a colorectal surgeon, see Table 1. One stage 1 anal cancer was detected. The most common incident diagnoses were skin tags, haemorrhoids, warts, fissures and enlarged prostate.

Of 241/327 mean (71%) men who completed the final questionnaire, 95% (229/241) would continue to have an annual DARE beyond the study, and 79% (190/241) felt more likely to consult a doctor if they found an abnormality or had anal symptoms.

This study concluded that integrating an early cancer detection programme into routine HIV clinical care is feasible, especially in settings where anal cytology and high-resolution anoscopy services are unavailable. Although referral rates for surgery remained low over the two years, the involvement of HIV doctors in early anal cancer detection could help with early detection which in turn is associated with better outcomes.

Table 1: Frequency of abnormalities and referrals

Baseline Year 1 Year 2
No abnormality 241 (71%) 214 (80%) 209 (78%)
Anbormality, no referral 69 (22%) 50 (19%) 46 (17%)
Abnormality, with referral 17 (5%) 4 (1%) 12 (5%)


Ong J et al. Early detection of anal cancer in men who have sex with men (MSM) living with HIV by incorporating digital anorectal examinations (DARE) into routine HIV care: A prospective cohort study. AIDS 2018, 23-27 July 2018, Amsterdam. Poster TUPEB083.

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