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 HPV (Human Papillomavirus), the cause of this potentially deadly disease.
Almost no data exists on the prevalence of anal cancer in South Africa, 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 program for this disease.
Dr Mark Faesen, a specialist gynaecologist working with the Clinical HIV Research Unit (CHRU) in its cervical cancer screening and prevention clinic, explains that 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 South Africa is clear, yet no one has taken the initiative to start screening. The incidence of anal cancer in South Africa is unknown, as it's not being tracked or reported. Many patients living with HIV in South Africa do not realise that they are at risk of contracting anal pre-malignancies or malignancies," says Dr Faesen.
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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," Faesen adds.
The challenge is not just medical — it's structural. Currently, no public sector healthcare provider in South Africa offers anal cancer screening, and the private sector is similarly lacking in resources or 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, South Africa lags behind countries like 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 pre-malignant 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 coordinated, 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.
Dr Faesen concludes, "It's time for change, and it starts with research, education for healthcare providers, and funding for life-saving screenings."
