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The cancer no one talks about – until now

It's the disease that nobody wanted to talk about. But now with the recent death of actress Farrah Fawcett from anal cancer, a lot of people are asking questions about this under-recognized disease.

Mark Welton, MD, an expert in anal cancer, said the disease carries a lot of stigma because of the misconception that it's solely the result of anal receptive intercourse. "That's absolutely not true," said Welton, Stanford's chief of colon and rectal surgery.

In fact, anal cancer is caused by the human papillomavirus, or HPV, the same virus that causes cervical cancer. HPV is ubiquitous; anyone who has had a sexual interaction has been exposed to the virus, he said. But some people don't effectively fight it off.

"It is a virus that for some unknown reason is able to elude the immune system effectively enough in a small subset of patients. It may not be completely cleared from the body and lead to chronic inflammation. And that inflammation can lead to cancer," said Welton, the interim medical director of the Clinical Cancer Center at Stanford.

Women are more prone to the disease. Of the 5,000 new cases reported every year, more than 3,000 are in women, according to the American Cancer Society. Women with a history of cervical cancer or cervical dysplasia (abnormal cells on the surface of the cervix) are at greater risk, Welton said. In addition, patients - both men and women - with compromised immune systems are at higher risk. And yes, people who have anal receptive sex are at greater risk, too.

Welton has been trying for years to get the word out about anal cancer, but it's been a challenge, as my colleague Stephanie Pappas noted in a post last week. An interview Welton did with NBC network news in 2002 was canned because the word, "anal," couldn't be uttered on the air. Now people are talking about the disease, and that's a good thing, he said, as anal cancer can be prevented.

In 2008, he published a paper involving 245 high-risk patients that proved this point. All of the patients had pap smears, and those with abnormal results were treated in the operating room in a procedure that destroyed the pre-cancerous cells.

Only 1.2 percent of the patients progressed to cancer. That's clearly preferable to chemotherapy and radiation for the disease, he notes, which not everyone can tolerate. Sadly, treatment does not work for all; more than 700 Americans are expected to die of anal cancer this year.

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