Anal Cancer Screening for Gay and Bi Men: What to Know

Anal cancer is rare in the general population. But gay and bisexual men face a much higher risk. New international guidelines now recommend regular screening for some groups. The goal: catch problems early, before they become cancer.

This article explains what the latest research says. It also shows who should consider screening, and how the tests work.

Why anal cancer matters for gay and bi men

Anal cancer is mostly caused by the human papillomavirus (HPV). HPV is very common. Most people clear it without problems. But sometimes the virus stays and causes cell changes. Over years, these changes can turn into cancer.

Men who have sex with men have higher rates of anal HPV infection. The risk is even higher for men living with HIV. According to the US National Cancer Institute, gay and bisexual men with HIV have an anal cancer risk up to 80 times higher than the general male population. For HIV-negative gay men, the risk is around 20 times higher.

For comparison: cervical cancer rates in women dropped sharply after screening became standard. Experts hope anal screening can do the same.

The ANCHOR study: a turning point

In 2022, the ANCHOR study changed how doctors think about anal cancer. The trial followed more than 4,000 people living with HIV. Researchers found that treating pre-cancer cell changes lowered the cancer risk by 57 percent. The results were published in the New England Journal of Medicine.

Because of ANCHOR, the US International Anal Neoplasia Society released new screening guidelines in 2024. They recommend regular checks for high-risk groups. Several European countries are now updating their own protocols.

Who should consider screening

Not everyone needs anal cancer screening. Current expert guidance focuses on groups with the highest risk:

• Men who have sex with men and live with HIV, from age 35
• HIV-negative gay and bisexual men from age 45
• People with a history of anal warts or HPV-related cancers
• People who have had organ transplants and take immune-suppressing drugs

If you are in one of these groups, talk to your doctor or HIV specialist. In the Netherlands, the HIV treatment centres and Soa Aids Nederland can point you to the right care.

How the tests work

Screening usually starts with a simple test. Here are the main options:

Anal cytology (anal Pap smear)

A doctor or nurse uses a small swab to collect cells from the anal canal. The test takes a minute. There is no pain, just mild pressure. The cells go to a lab. They are checked for changes that could turn into cancer.

Digital anal rectal examination (DARE)

The doctor uses a gloved finger to check for lumps or hard spots. This is quick and simple. It can find tumours that a swab might miss. Many guidelines now recommend DARE once a year for high-risk men.

High-resolution anoscopy (HRA)

If a Pap smear shows abnormal cells, the next step is HRA. The doctor uses a small scope with a strong light. Suspicious spots can be biopsied or removed during the same visit. HRA is more involved but is still done without general anaesthesia.

What the results mean

Most abnormal results are not cancer. They show cell changes called anal intraepithelial neoplasia, or AIN. Low-grade AIN often goes away on its own. High-grade AIN needs treatment because it can become cancer over time.

Treatments include freezing the cells, laser therapy, or applying special creams. These procedures are usually done in a clinic. Recovery is fast.

HPV vaccination still matters

Screening finds problems early. But prevention is even better. The HPV vaccine protects against the strains that cause most anal cancers. In the Netherlands, the vaccine is now offered free to boys and girls from age 10. Adults up to age 26, and sometimes older, can also benefit.

The RIVM advises gay and bisexual men to discuss HPV vaccination with their GP or sexual health clinic. The vaccine works best before HPV exposure. But studies show it can still help adults who are already sexually active.

Access in the Netherlands and Europe

Access to anal cancer screening varies. In the Netherlands, most HIV treatment centres offer it for patients living with HIV. For HIV-negative men, access is more limited. Some Centrum Seksuele Gezondheid clinics can refer patients to specialists.

In the UK, the NHS does not yet offer routine anal cancer screening, but pilot programmes are running. France and Spain have made progress with screening in HIV clinics. The European AIDS Clinical Society now includes anal cancer screening in its standard treatment guidelines.

For more on related preventive care, see our explainers on Doxy-PEP for STI prevention and mpox vaccination for gay and bisexual men.

What you can do now

If you are a gay or bisexual man, especially if you are over 35 or living with HIV, here are practical steps:

1. Ask your GP or HIV specialist about anal cancer screening.
2. Check if you have had the HPV vaccine. If not, ask about catching up.
3. Watch for symptoms: bleeding, lumps, pain, or itching that does not go away.
4. Do not assume symptoms are just haemorrhoids. Get them checked.

Anal cancer is highly treatable when found early. Five-year survival for early-stage disease is over 80 percent, according to the WHO. The challenge is that many cases are diagnosed late, because people delay seeking help.

The bigger picture

Anal cancer screening for gay and bisexual men is where cervical cancer screening was 40 years ago. The science is now clear. Access still needs to catch up. With proper screening, most cases could be prevented or caught at a curable stage.

Talking openly with your doctor is the first step. The conversation may feel awkward. But a five-minute exam can save your life.