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Original research
Psychological and utility-based quality of life impact of screening test results for anal precancerous lesions in gay and bisexual men: baseline findings from the Study of the Prevention of Anal Cancer
  1. Erin Cvejic1,
  2. Isobel Mary Poynten2,
  3. Patrick J Kelly1,
  4. Fengyi Jin2,
  5. Kirsten Howard1,
  6. Andrew E Grulich2,
  7. David J Templeton2,3,4,
  8. Richard J Hillman2,5,
  9. Carmella Law5,
  10. Jennifer M Roberts6,
  11. Kirsten McCaffery1
  12. on behalf of the SPANC study team
    1. 1 Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
    2. 2 The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
    3. 3 Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
    4. 4 RPA Sexual Health Service, Sydney Local Health District, Camperdown, New South Wales, Australia
    5. 5 St Vincent's Hospital, Sydney, New South Wales, Australia
    6. 6 Cytopathology Department, Douglass Hanly Moir Pathology, Macquarie Park, New South Wales, Australia
    1. Correspondence to Professor Kirsten McCaffery, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; kirsten.mccaffery{at}


    Objective Gay, bisexual and other men who have sex with men (GBMSM), particularly HIV-positive GBMSM, are at increased anal cancer risk compared with the general population. This study examined the psychological and quality of life (QoL) impact of receiving abnormal anal cancer screening results during the baseline visit of the Study of the Prevention of Anal Cancer (SPANC).

    Methods SPANC was a prospective cohort study of the natural history of anal human papillomavirus (HPV) and associated abnormalities in GBM aged 35 years and over. Participants completed questionnaires including aspects of health-related QoL (HR-QoL) and psychosocial functioning at baseline. Participants underwent procedures including an anal swab for cytology, and high-resolution anoscopy with biopsy of any possibly HPV-related abnormality. Questionnaires were readministered 2 weeks and 3 months after participants were given cytology and histology results. Perceived test result served as the study factor.

    Results Participants with perceived abnormal results (n=232) reported poorer HR-QoL (mean difference=1.8; p=0.004) and lower utility-based QoL (mean difference=0.02; p=0.018) 2 weeks after screening than individuals with perceived normal results (n=268). These differences did not persist at 3-month follow-up. A greater proportion of participants who perceived their results as abnormal reported feeling worse than usual about their anal health and anal cancer fear (p’s<0.001), experienced more intrusive thoughts about their results (p’s≤0.006) and felt more likely to develop cancer than other gay men their age (p’s≤0.025) at both time points than those with perceived normal results.

    Conclusions Providing abnormal results may cause psychological distress and impact HR-QoL, with sustained intrusive thoughts, increased cancer worry and perceived cancer risk. The potential for psychological harm needs to be considered when implementing anal cancer screening programmes.

    • anal squamous cell carcinoma
    • anxiety
    • cancer screening
    • gay and bisexual men (GBM)
    • human immunodeficiency virus (HIV)
    • human papillomavirus (HPV)
    • psychological impact
    • quality of life

    Statistics from


    • Handling editor Adam Huw Bourne

    • Twitter Erin Cvejic (@ErinCvejic); Kirsten McCaffery (@KirstenMcCaffer).

    • Collaborators SPANC study team: Brian Acraman; Andrew Carr; Susan Carroll; David Cooper; Alyssa Cornall; Leonie Crampton; Christopher Fairley; Annabelle Farnsworth; Lance Feeney; Eddie Fraissard; Suzanne Garland; Andrew Grulich; Richard Hillman; Kirsten Howard; Fengyi Jin; Carmella Law; Matthew Law; Kirsten McCaffery; Patrick McGrath; Robert Mellor; Matthew O’Dwyer; Kathy Petoumenos; Piero Pezzopane; Samuel Phillips; Isobel Mary Poynten; Garrett Prestage; Adele Richards; Jennifer Roberts; Daniel Seeds; Sepehr Tabrizi; Dave Templeton; Julia Thurloe; Winnie Tong; Rick Varma.

    • Contributors IMP, FJ, KH, AEG, DJT, RJH and KM conceived and designed the study. EC, IMP, PJK, FJ, KH and KM analysed and interpreted the data. EC drafted the article. EC, PJK, FJ, IMP, KH, AEG, DJT, RJH, CL, JMR and KM critically revised the article and contributed to the interpretation of the results.

    • Funding The SPANC study is funded by an NHMRC Program Grant (Sexually transmitted infections: causes, consequences and interventions; Grant No 568971) and a Cancer Council NSW Strategic Research Partnership Program Grant (Preventing morbidity and mortality from anal cancer; Grant No 13-11). Cytological testing materials were provided by Hologic (Australia). The Kirby Institute is affiliated with the Faculty of Medicine, UNSW, Australia, and funded by the Australian Government Department of Health and Ageing. AEG (No 1081175) and KM (No 1121110) are supported by NHMRC Professorial Research Fellowships.

    • Disclaimer The funding sources played no role in the analysis of the data. The views expressed in this publication do not necessarily represent the position of the Australian Government.

    • Competing interests AEG has received honoraria and research funding from CSL Biotherapies, and honoraria and travel funding from Merck. RJH has received support from CSL Biotherapies and MSD. JMR has received commercial research support from Hologic.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval for this study was obtained from St Vincent’s Hospital Sydney Human Research Ethics Committee (Approval reference: No 09/203).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.

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