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HEALTH

New test for anal cancer

Breakthrough will save lives
November 06, 2008

LONDON — British scientists have developed a new test to detect early signs of anal cancer, which will potentially save thousands of lives.

The incidence of anal cancer is estimated as 37 per 100,000 in gay men, which is similar to the rate of cervical cancer in women before the introduction of pap smear screening. For gay men who are HIV-positive, the incidence is about twice as great – around 75 per 100,000.

The study, funded by the UK's Medical Research Council (MRC) and Cancer Research UK, is published in the American journal, Cancer Epidemiology Biomarkers and Prevention.

Lead author of the study, Dr Nick Coleman, said: "We have uncovered a more effective way to detect anal cancer in its early stages, meaning fewer people would have to undergo the rigours of radiotherapy and chemotherapy treatment.

"Anal cancer is a difficult disease to detect and many cases are identified after it becomes too late for people to undergo simple surgery to remove it. We wanted to create a test which was easier to perform and had a high rate of accuracy. This study suggests that MCM testing fits the bill very well indeed."

Gay human rights campaigner Peter Tatchell, who in 2003 successfully lobbied the UK government to take action on anal cancer, said:
"This new screening test is likely to save thousands of lives by ensuring earlier diagnosis and treatment. The Cambridge medical team have done magnificent, life-saving work. I offer them my congratulations and appreciation."

"Two decades ago, I deduced that if the Human Papilloma Virus (HPV) causes cervical cancer in women, it must also have the potential to cause anal cancer in people who have anal sex, especially gay and bisexual men.

"I lobbied the UK government for two decades to take action but was constantly rebuffed. The British Medical Journal and The Lancet declined to report the issue and Cancer Research UK dismissed it.

Everyone said there wasn't enough credible research to justify action. But that was why I was urging research, in order to establish the incidence and risk, and devise screening methods and treatment protocols.

"From the mid-1990s, I stepped up my prodding of the medical establishment. I wrote to successive Health Ministers and STI specialists, urging the introduction of anal pap smears of at risk populations and the funding of research programmes. The replies were dismissive and illogical; typically arguing that the science on this issue was "uncertain".

"This was a limp justification for doing nothing. If the medical knowledge was inadequate, I argued this was all the more reason to fund pilot studies.

"Undeterred, I collated fragments of US research showing that pap smears could be an effective screening tool for anal cancer, and that screening is cost-effective and can save lives.

"In 2003, I lobbied the then newly appointed Health Secretary, Dr John Reid.

I advised him: 'Screening has massively reduced deaths from cervical cancer. A similar screening programme among men and women who have anal sex could also identify cancerous and pre-cancerous irregularities; ensuring earlier treatment and enhanced survival. It cannot be medically justifiable to treat people at risk of anal cancer differently from those at risk of cervical cancer'.

"My letter urged the Department of Health to fund pilot studies at STI clinics, including anal pap smear screening programmes to detect the prevalence of HPV infection and anal cancer among risks groups such as gay and bisexual men.

"Dr Reid immediately referred my letter to the National Screening Committee (NSC). Within two weeks the NSC met and agreed 'the existing evidence should be reviewed and assessed', with a view to funding 'further research'.

"An evaluation project was established by Dr Muir Gray of the NSC. Following a seminar of experts at the British Medical Association headquarters, two working groups were formed to examine future research avenues, the viability of screening programmes and the development of new experimental therapies.

"This has resulted in the coordination and cross-referencing of anal cancer research and treatment throughout the UK, including new therapies and test methods, such as the new diagnostic method devised by the Cambridge team," said Mr Tatchell.

Medical Research Council � News Release

A new 'smear test' to prevent anal cancer

Scientists at the Medical Research Council (MRC) have found a new and improved technique to detect anal cancer that may cause the number of people dying from the disease to drop significantly.

The research, carried out at the MRC Cancer Cell Unit in Cambridge, explores using minichromosome maintenance proteins (MCMs) to detect pre-cancerous and cancerous cells in the anus. The study, funded by the MRC and Cancer Research UK, is published today in the American journal Cancer Epidemiology Biomarkers and Prevention.

MCMs have been used to find pre-cancerous and cancerous cells in other areas of the body more accurately and effectively but this is the first time they have been used to detect anal cancer.

Lead author of the study, Dr Nick Coleman, said: "This is welcome news for people who are at high risk of developing anal cancer. We have uncovered a more effective way to detect anal cancer in its early stages, meaning fewer people would have to undergo the rigours of radiotherapy and chemotherapy treatment.

"Anal cancer is a difficult disease to detect and many cases are identified after it becomes too late for people to undergo simple surgery to remove it. We wanted to create a test which was easier to perform and had a high rate of accuracy. This study suggests that MCM testing fits the bill very well indeed."

The study first involved screening anal tissue samples from different patients to pick up the biological differences between normal cells and cancer cells. The scientists found that normal tissue lacked MCMs whereas anal cancer and pre-cancer had an abundance of MCMs. The power of MCM testing was then shown in an independent group study of 235 anal smears from 144 subjects.

The test successfully identified 84% of the patients with anal pre-cancer, without producing a high rate of false alarms in people without disease.

Dr Coleman said: "This is a much better overall performance than existing methods of detecting anal disease, which either miss too many cases or show up as positive when no disease is actually there. MCM tests can also be read by a computer, which would avoid the risk of human error and be a cheaper option too."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "MCMs are already showing promise as early markers to be used in screening for a number of cancers, so it is encouraging to see this research progressing.

"We must also continue to raise awareness of the disease, particularly among people in high risk groups such as gay and bisexual men so they can take action if they have symptoms."

The incidence of anal cancer is estimated as high as 37 per 100,000 in gay men and about double if they are also HIV-positive.

Human rights campaigner Peter Tatchell has lobbied for anal cancer screening and treatment programmes targeted at the higher risk gay community for many years.

He said: "For gay and bisexual men who are at risk of anal cancer, these tests are an important medical breakthrough. They will help save lives. With this reliable screening test, signs of anal cancer will be detected earlier, leading to speedier, more effective treatment."

Notes:
  • Improved screening for anal neoplasia by immunocytochemical detection of minichromosome maintenance proteins, Cancer Epidemiology Biomarkers and Prevention 2008; 17:2855�2864.
  • Currently up to 50% of patients with anal cancer present with an advanced stage of the disease � a mean tumour size of 3-4cm � meaning they have to undergo combined radio and chemotherapy. If anal cancer is detected at less than 2cm in size, it can be treated by simple excision. – Issued by OUTRAGE!


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