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DESCRIPTION: However there are no clear guidelines on how to effectively screen for anal cancer.

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Can Anal Cancer Be Found Early?

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However there are no clear guidelines on how to effectively screen for anal cancer. As earlier diagnosis of anal cancer is associated with increased survival, innovative ways such as utilizing anal self-examination to identify anal cancer should be explored.

This study explored acceptability and barriers to implementing ASE as a method of anal cancer screening. Framework analysis was used to identify themes.

Only 5 men were currently confident in detecting an abnormality. Whilst men were generally comfortable with the idea of utilizing ASE as a means for detecting anal cancer, potential barriers identified operated at three levels: The preference for health professional examination and inadequate physical flexibility may preclude its use for some men.

Future trials to confirm its wider acceptability will be needed before undertaking an effectiveness trial for detecting anal cancer. Incidence rates of up to perhave been reported in several countries [ 3Anal doctor doing exam female ], making it Anal doctor doing exam female of the most common cancers in HIV-positive MSM [ 5 ].

Anal cancer is associated with substantial mortality but early diagnosis is associated with considerably improved survival. These data highlight the Anal doctor doing exam female of early diagnosis. Currently anal cancers are usually diagnosed late with an average size of 2. In one study symptoms were present for an average of 22 weeks before men presented to a health care provider.

Many experts suggest that implementing early detection of anal cancer using regular digital ano-rectal examination DARE by doctors should be routine in Anal doctor doing exam female at highest risk i. The term DARE has been used specifically for anal cancer studies to emphasize the importance of feeling the anal canal as part of the examination [ 13 ]. This also includes an examination of the perianal region the area of skin extending up to 5 cm from the anal verge.

Anal doctor doing exam female recent study of HIV-positive MSM with anal cancer found that early anal cancer detection was possible if men were closely followed up with regular DARE by a health professional [ 13 ]. However it is not known if anal cancers may be detected earlier and more frequently by encouraging self-examination in addition to regular DARE by a health professional.

Self examination has been investigated for breast cancer [ 14 ], skin cancer [ 15 ], and testicular cancer [ 16 ]. Although self-examination provides a means for early detection, the recommendation by Anal doctor doing exam female authorities for self-examination remains controversial and inconsistent.

For example, although many women find their own breast cancers, in countries with established breast screening programs, breast self-examination is unlikely to provide additional benefits in decreasing breast cancer mortality [ 17 ]. It is important therefore to determine the settings where self-examination may still Anal doctor doing exam female clinical benefit.

Given that there are no established anal cancer screening programs in many countries and that anal cancers are currently diagnosed late [ 9 ], teaching men to be aware of symptoms and changes in their anus may lead to earlier presentations of anal cancer.

An anal self-examination ASE would involve teaching men to feel the skin in the peri-anal area and to perform a self-DARE, palpating for a lumps or ulcer. If ASE was to work effectively it would be necessary as part of an education program that patients were strongly encouraged to consult a doctor if any new lesions of concern were identified.

Before ASE can be tested in the population for its effectiveness in detecting anal cancer, the views on the acceptability and feasibility of ASE from those at highest risk for anal cancer i. To ensure maximum variation sampling, a quota of up to 5 men from each of four age categories were selected: Men with past or current anal cancer, or who were not fluent in English were excluded.

During a consultation recruiting doctors gave eligible men an information and consent form, and invited participation in the study. The researcher JO then contacted the patient to answer further questions and to organize a convenient time for the interview.

Written consent was obtained at the time of the interview. The interviews were recorded for later transcription and thematic coding. An ASE was defined as self-examination of both the anal canal and perianal region. A manikin Rectal examination Trainer Mk 2, part no: As this was an exploratory study on the attitudes towards ASE, we did not conduct any education on how to feel for an anal cancer. Interviews were undertaken until no new insights were captured i.

Data were analyzed using an iterative approach. After each interview a preliminary analysis was performed to allow identification of new themes emerging from the interviews to be included in subsequent interviews.

Once all interviews were completed, content analysis was performed to block, group and label the data to identify emerging themes. We looked for differences in themes between older and younger participants, and those who had performed ASE to look for anal abnormalities compared to those who performed ASE for sexual reasons only. Coding was conducted independently by two researchers one sexual health clinician and one sexual health researcher and then Anal doctor doing exam female with the research team to achieve consensus Anal doctor doing exam female common themes.

Finally, coding for themes and concepts was used to frame the remaining data. We adhered to the qualitative research review guidelines RATS [ 18 ] in reporting the findings of this research. Of 22 men approached, two declined one was too Anal doctor doing exam female, and the other not interested.

Men described themselves as generally healthy mean score of 75 on a general scale of 0 towhere equated to perfect health. They were a relatively pro-active group with many describing exercise and dietary changes as part of their health maintenance.

Seven men practiced testicular self-examination and three men skin self-examination on an ad hoc basis. Currently none Anal doctor doing exam female doing this on a regular basis to screen for anal cancer. Only a minority 5 men felt confident in detecting an abnormal lesion. Four men had found abnormalities themselves and presented to the doctor for further examination 1 skin tag, 1 scarring, 2 haemorrhoids.

Men described how they would conduct Anal doctor doing exam female ASE. The location of performing an ASE would either be in the shower, bathroom or bedroom. The positions adopted did not appear to be related to the age of participants and varied from most frequently used to least: The majority of men would use some sort of lubricant in the process 13 men would use KY jelly, 2 use soap and a minority 4 men would also use a glove. Four men would use a mirror to also try to visualize the peri-anal area.

The majority of men felt comfortable Anal doctor doing exam female anal issues within a medical setting. Some men expressed that the ease of raising the issue stemmed from their sexual identity. In a medical context I have absolutely no problem at all, none whatsover… 62 years old, living with HIV for 7 years. If it was a general GP probably a different story. I think that an HIV doctor, and also a gay doctor, has a much better understanding of what people risk being gay.

I always have found those personal things easier to talk about with a female doctor. Some participants recognised that underlying their choice of doctor with whom to discuss anal issues was a trusting relationship. Despite the majority of men being comfortable in addressing anal issues with a health professional, only two men reported that their Anal doctor doing exam female had raised the issue of anal cancer.

As a result of the paucity of discussions around anal cancer, the understanding of anal cancer was poor amongst participants. Participants reported that the majority of doctors would only discuss anal issues if the participant specifically brought the topic up.

Indeed the majority of participants suggested that doctors should be more pro-active in addressing anal health. Many men suggested the manikin was unnecessary for showing them what is meant by the perianal region, but a stronger reaction to the pictures of anal cancer was obvious. It should make anyone, you know gay or not, examine themselves 47 years old, living with HIV for 11 years.

Enthusiasm for Anal doctor doing exam female was especially evident in younger participants, who saw ASE as Anal doctor doing exam female and who approved of the concept of early detection.

Everybody should be doing it, no matter what part of the body it is. Despite perception of some discomfort, most men conveyed that they would still allow an anal examination if there were clear benefits.

There is something about a digital examination that feels more intimate… and I vaguely feel a little bit uncomfortable with a doctor doing that. But not enough to stop me doing it. However there was agreement that not all men might be comfortable with any sort of anal examinations. For men who have never performed an ASE to look for anal abnormality before, they discussed the potential for anxiety if an abnormality was detected.

Interestingly, this was always spoken of in the third person, as if to distance themselves from such anxious men. The only downside is making people slightly paranoid potentially. This anxiety seemed to stem predominantly from recognition that following an abnormal ASE further investigation would be required. The men who had not performed ASE to look for abnormality before preferred anal examinations to be performed only by a medical expert, not themselves. In addition some men stated that conducting an examination with their own finger would be too difficult as it may lead to too many sensations and had sexual connotations.

What if I miss something… [ASE is] not your normal medical procedure. It would turn on a whole lot of ranges of feelings and sensations as well.

Sexual desires, all that kind of stuff. Two knowledge barriers were noted — lack of awareness of anal cancer risk and ignorance of what to look for during ASE. There was frustration amongst participants that they did not have enough Anal doctor doing exam female. I can tell you it never crossed my mind that I should be looking for anal cancer…. A result of this lack of awareness may be a tendency Anal doctor doing exam female ignore the link between anal symptoms and potential anal cancer.

Furthermore, the lack of knowledge led to misconceptions of risk factors, misperception of personal risks and assumptions of an association between anal cancer and other cancers. You think that helps? Although men felt comfortable in noticing a change in their anal region, there was no specific understanding of what they should be looking for when they examined themselves. Whilst largely supportive of ASE, men acknowledged that there may be a few practical barriers to an adequate examination, even for younger participants.

So it can be hard to look after if something goes wrong. Whilst a few expressed potential issues with the physical flexibility needed for an adequate examination, the majority including older participants believed that flexibility was not a major barrier.

When I was younger, I was quite flexible and reaching around and examining myself was quite - it was easy to do, because I was always constantly checking for warts… the external part of it would be quite easy to detect. But the internal part I find would be a little bit more difficult. A minority of participants expressed a concern around hygiene prior to ASE. For these men, it was important for them to be completely clean before they would conduct an ASE.

Whilst self examination has been investigated for screening of other cancers [ 19 — 21 ], this is the first study to explore ASE as a means for anal cancer detection. If ASE can detect anal cancers earlier than its current average size of 2.


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