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Anal Pap Testing and Cancer

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Last Modified: January 14, 2010

Dear OncoLink "Ask The Experts,"

How effective are anal pap tests that are offered in the gay community?

Najjia N. Mahmoud, MD, Assistant Professor of Surgery at the Hospital of the University of Pennsylvania in the Division of Colon and Rectal Surgery, responds:

I'm unclear on the efficacy of anal pap tests. There is a lot of controversy in the medical community as to whether this method of surveillance and detection is effective. There is a group in San Francisco who believes that detection and ablation of anal dysplasia is very important, and there is the "east coast" point of view, which opts to just survey or monitor dysplasia noting that much of it can disappear or regress over time.

The medical community is still trying to decide how to implement anal Pap smears. It is unclear. It is not adequate surveillance for those who have already had condyloma or cancer and are being followed. Those individuals need a proctoscopy or anoscopy with a digital rectal exam to actually visualize the area. Unlike vaginal/vulvar/ or cervical dysplasia and cancer, extensive removal of skin or mucosa over and around the anus results in critical loss of function which can lead to incontinence. Because of this, we emphasize surveillance to a great extent and not so much surgery for dysplasia (at least on the "East Coast"!).