Marcia Cross, actress best known for her work on the hit television show Desperate Housewives, recently revealed that she is being treated for anal cancer, which is seen in less than 1% of cancer cases each year. The actress wanted to share her story, not only to raise awareness of this rare cancer, which may go undetected well after the cancer develops, but also to bring the importance of the human papillomavirus (HPV) vaccine to the public. Just as her husband, Tom Mahoney’s, throat cancer, diagnosed in 2009, was caused by HPV, so is her anal cancer.
Cancers related to HPV infections are becoming more widely recognized, and, thanks to destigmatizing cancers of the genital tract and lower gastrointestinal tract, these cancers are being detected earlier and earlier. The actress’s cancer was discovered when she had no symptoms, but was having a routine gynecologic check-up. Typically, one thinks of gynecologic exams to include something called a pap smear, where a sampling of cells are taken from the cervix, looking for pre-cancerous or cancerous cells, infections (including HPV), or visible or palpable masses of the cervix, uterus, ovaries, vagina, and vulva. In addition, a rectal examination can be performed (by a gynecologist or primary care physician) to evaluate for masses, but even more informative, these rectal examinations can be performed to test for occult blood (occult in this case meaning no obvious signs of bleeding) in the gastrointestinal tract.
This simple screening test, known as FOBT, or fecal occult blood test, where a sampling of the fluid from the gloved finger from a rectal exam is placed onto a cassette, and a “positive” indicates blood somewhere in the lower intestines. It has been one of the most widely used early screening tests for colon cancers, which often go undetected for months or even years before symptoms develop. A positive FOBT may indicate something relatively minor, such as internal hemorrhoids, benign polyps, or anal fissures, to more severe problems such as colorectal or anal cancers. A positive FOBT may be the only abnormality, with no symptoms or history of bleeding, but it should lead to further evaluation, including colonoscopy.
While colorectal cancer is the second-leading cause of cancer deaths in the United States, anal cancer is much less common. But unlike colorectal cancers, it is more likely that anal cancers will be due to HPV infections. In a prior Forbes article, the importance of the HPV vaccine reducing cancers not only of the cervix, but also of the throat, was described. In addition, HPV in the female genital tract can be transmitted from a pregnant mother to the fetus. An entity called RRP, or recurrent respiratory papillomatosis, is an HPV-based disease of infants and children, with warts in the airways leading to airway blockage, breathing problems, and a lifetime of surgeries to remove the warts on a regular basis.
There continues to be debate on the implications and importance of pre-teen girls and boys receiving the HPV vaccine, as many have erroneously thought that receiving the vaccine is an entree into early sexual activity. No study has demonstrated this. However, there is already strong evidence that providing the vaccine is lowering the incidence of cervical cancer. If the HPV vaccine is administered more routinely, it will ideally lead to reduction in other cancers, including throat cancers and anal cancers.