SA’s most ignored disease: Anal cancer

Dr Mark Faesen advocates why South Africa needs a proper anal cancer screening programme for at-risk populations.

Despite South Africa’s status as home to the world’s largest population living with HIV, the country has made no progress in addressing anal cancer screening and prevention. The absence of anal Pap smears and proper cancer screening guidelines leaves at-risk populations vulnerable, with this disease receiving almost no attention.

HIV significantly elevates the risk of anal cancer, but other at-risk groups include those with sexually transmitted infections and human papillomavirus (HPV), the cause of this potentially deadly disease.

Almost no data exists on the prevalence of anal cancer in SA, and no efforts are made toward prevention or treatment. This healthcare gap, particularly for those at high risk, calls for the initiation of a screening programme for this disease.

Why the need for a screening programme?

Anal cancer in the general population is rare and therefore not cost-effective to screen. However, screening for anal cancer should be as routine as cervical cancer screening for women living with HIV, women who have other HPV-related diseases, such as genital or peri-anal warts, and all women with a history of pre-malignant or malignant lesions either on the cervix or the vulva.

Men who are living with HIV and have genital warts are also at increased risk for HPV-related abnormalities in the anal canal and should also undergo anal cancer screening.

The need for anal cancer screening in SA is clear, yet no one has taken the initiative to start screening. The incidence of anal cancer in SA is unknown, as it’s not being tracked or reported. Many patients living with HIV in SA don’t realise that they are at risk of contracting anal premalignancies or malignancies.

Funding

A key step toward improvement requires funding for anal cancer screening. With the right resources, we can raise awareness and offer life-saving tests to those who need them most.

The challenge isn’t just medical, it’s structural. Currently, no public sector healthcare provider in SA offers anal cancer screening, and the private sector is similarly lacking in resources and guidelines for the disease.

The lack of awareness among healthcare professionals only exacerbates the problem, with many medical staff unaware of the risks and the correct procedures for anal cancer screening.

Although this type of screening is growing globally, SA lags behind the United States and Western Europe, where they are well established.

At-risk individuals need education to prevent the disease through screening and early treatment of premalignant lesions, which requires the backing of the public health sector.

Immediate action needed

This situation requires urgent, collective action from the South African National Department of Health and the medical community. A co-ordinated, well-funded effort to bring anal cancer screenings and education to the forefront of South Africa’s health agenda is necessary to save lives and prevent further tragedies.

It’s time for change, and it starts with research, education for healthcare providers, and funding for life-saving screenings.

Dr Mark Faesen is a specialist gynaecologist and reproductive medicine specialist. He works with the Clinical HIV Research Unit (CHRU) in its cervical cancer screening and prevention clinic. He recently started raising awareness about anal cancer screening in SA. His pioneering work includes conducting anal Pap smears for high-risk patients visiting the HIV clinic and pushing for funding to establish comprehensive screening programmes.

Header image by Freepik